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Oklahoma OK
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2024 Regular Session
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SB351
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OK

Oklahoma Senate Bill SB351

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Oklahoma 2024 Regular Session

Oklahoma Senate Bill SB351 Compare Versions

Only one version of the bill is available at this time.

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1
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4	4		Req. No. 1576 Page 1 1
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53	53		STATE OF OKLAHOMA
54	54
55	55		1st Session of the 59th Legislature (2023)
56	56
57	57		SENATE BILL 351 By: Seifried
58	58
59	59
60	60
61	61		AS INTRODUCED
62	62
63	63		An Act relating to health insurance; amending 36 O.S.
64	64		2021, Sections 3624 and 6055, which relate to
65	65		assignment of policies and selection of care provider
66	66		by an insured; conforming language; expanding health
67	67		care providers to be paid a n assigned benefits claim;
68	68		requiring insurer failing to p ay assigned benefits
69	69		claim to pay certain costs; authorizing Insurance
70	70		Commissioner to impose civil fine for certain
71	71		violation; requiring fine be deposited in the State
72	72		Insurance Commissioner Revolvin g Fund; providing for
73	73		terms of assignability; updating statutory reference;
74	74		and providing an effective date.
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79	79		BE IT ENACTED BY THE PEOPLE OF THE ST ATE OF OKLAHOMA:
80	80		SECTION 1. AMENDATORY 36 O.S. 2021, Section 3624, is
81	81		amended to read as follows:
82	82		Section 3624. Except as provided in subsection D of Section
83	83		6055 of this title, a policy may be assignable or not assignable, as
84	84		provided by its terms. Subject to its terms relating to
85	85		assignability, any life or accident and health p olicy, whether
86	86		heretofore or hereafter issued, under the terms of which the
87	87		beneficiary may be chang ed upon the sole request of the insured, may
88	88		be assigned either by pledge or transfer of title, by an assignment
89	89		executed by the insured alone and delivered to the insurer, whether
90	90
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141	141		or not the pledgee or assignee is the insurer. Any such assignment
142	142		shall entitle the insurer to deal with the assignee as the o wner or
143	143		pledgee of the policy in accordance with the terms of the
144	144		assignment, until the insurer has rec eived at its home office
145	145		written notice of termination of the assignment or pledge, or
146	146		written notice by or on behalf of some other person claiming some
147	147		interest in the policy in conflict with the assignment.
148	148		SECTION 2. AMENDATORY 36 O.S. 2021, Section 6055, is
149	149		amended to read as follows:
150	150		Section 6055. A. Under any accident an d health insurance
151	151		policy, hereafter renewed or issued for delivery from out of
152	152		Oklahoma or in Oklahoma by any insurer and covering an Oklahoma
153	153		risk, the services and procedures may be performed by any
154	154		practitioner selected by the insured, or the parent or guardian of
155	155		the insured if the insured is a minor, if the services and
156	156		procedures fall within the licensed scope of practice of the
157	157		practitioner providing the same.
158	158		B. An accident and health insurance policy may:
159	159		1. Exclude or limit coverage for a parti cular illness, disease,
160	160		injury or condition; but, except for such exclusions or limits,
161	161		shall not exclude or limit particular services or procedures that
162	162		can be provided for the diagnosis and treatment of a covered
163	163		illness, disease, injury or condition, if such exclusion or
164	164		limitation has the effect of discriminating against a particular
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216	216		class of practitioner. However, such services and procedures, in
217	217		order to be a covered medical expense, must:
218	218		a. be medically necessa ry,
219	219		b. be of proven efficacy, and
220	220		c. fall within the licensed scope of practice of the
221	221		practitioner providing same; and
222	222		2. Provide for the application of deductibles and copayment
223	223		provisions, when equally applied to all covered charges for services
224	224		and procedures that can be provided by any p ractitioner for the
225	225		diagnosis and treatment o f a covered illness, disease, injury or
226	226		condition.
227	227		C. 1. Paragraph 2 of subsection B of this section shall not be
228	228		construed to prohibit differences in cost -sharing provisions such as
229	229		deductibles and copayment provisions between practitioners who, and
230	230		hospitals, and ambulatory surgical centers , home care agencies, or
231	231		other health care providers or facilities that , are licensed or
232	232		certified by the state who are that may or may not be participating
233	233		preferred provider organization providers and practitioners,
234	234		hospitals and ambulatory surgical centers who are not participating
235	235		in the preferred provider organization, subject to the following
236	236		limitations:
237	237		a. the amount of any annual ded uctible per covered person
238	238		or per family for treatment in a hospital or
239	239		ambulatory surgical center that is not a preferred
240	240
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291	291		provider shall not exceed three times the amount of a
292	292		corresponding annual deductible for treatmen t in a
293	293		hospital or ambulatory surgi cal center that is a
294	294		preferred provider,
295	295		b. if the policy has no deductible for treatm ent in a
296	296		preferred provider hospital or ambulatory surgical
297	297		center, the deductible for treatment in a hospital or
298	298		ambulatory surgical c enter that is not a preferred
299	299		provider shall not exceed One Thousand D ollars
300	300		($1,000.00) per covered -person visit,
301	301		c. the amount of any annual deductible per covered person
302	302		or per family treatment, other tha n inpatient
303	303		treatment, by a practitioner that is not a preferred
304	304		practitioner shall not exceed three times the amount
305	305		of a corresponding annual deductible for treatment,
306	306		other than inpatient treatment, by a preferred
307	307		practitioner,
308	308		d. if the policy has no d eductible for treatment by a
309	309		preferred practition er, the annual deductible for
310	310		treatment received from a practitioner t hat is not a
311	311		preferred practitioner shall not excee d Five Hundred
312	312		Dollars ($500.00) per covered person, and
313	313		e. the percentage amount of any c oinsurance to be paid by
314	314		an insured to a practiti oner, hospital or ambulatory
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366	366		surgical center that is not a preferr ed provider shall
367	367		not exceed by more than thirty (3 0) percentage points
368	368		the percentage amount of any coinsurance payment to be
369	369		paid to a preferred provider.
370	370		2. The Insurance Commissioner has discreti on to approve a cost -
371	371		sharing arrangement which does not satisfy the limitations imposed
372	372		by this subsection if the Commissioner finds that such cost -sharing
373	373		arrangement will provide a reduction in premium cos ts.
374	374		D. 1. A practitioner who, and a hospital, or ambulatory
375	375		surgical center, home care agency, or any other health care provider
376	376		or facility licensed or certified by the state that, is not a
377	377		preferred provider shall disclose to the insured, in writing, th at
378	378		the insured may be responsible for:
379	379		a. higher coinsurance and deductibles, and
380	380		b. practitioner, hospital or ambulatory surgical center
381	381		charges which exceed the allowable charges of a
382	382		preferred provider.
383	383		2. When a referral is made to a nonparticipating hospital or
384	384		ambulatory surgical center, the referring practitioner must disclose
385	385		in writing to the insur ed, any ownership interest in the
386	386		nonparticipating hospital or ambulatory surgical center.
387	387		E. Upon submission of a claim by a practitioner , or a hospital,
388	388		home care agency, or ambulatory surgical center , or other health
389	389		care provider or facility licensed and certified by the state to an
390	390
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441	441		insurer on a uniform health care claim form adopted by the Insurance
442	442		Commissioner pursuant to Section 6581 of this title, the insurer
443	443		shall provide a timely explanation of benefits to the practitione r,
444	444		hospital, home care a gency, or ambulatory surgical center , or other
445	445		health care provider or facility licensed and certified by the state
446	446		regardless of the network participation status of such person or
447	447		entity.
448	448		F. Benefits available under a n accident and health insurance
449	449		policy, at the option of the insured, shall be assignabl e to a
450	450		practitioner who, or a hospital, home care agency , or ambulatory
451	451		surgical center, who or other health care provider or facility
452	452		licensed and certified by the state that has provided services and
453	453		procedures which are covered under the policy. A prac titioner,
454	454		hospital, home care agency , or ambulatory surgical center , or other
455	455		health care provider or facility licensed and certified by the state
456	456		shall be compensated directly by a n insurer for services a nd
457	457		procedures which have been provided when the fol lowing conditions
458	458		are met:
459	459		1. Benefits available under a policy have been assigned in
460	460		writing by an insured to the practitioner, hospital, home care
461	461		agency, or ambulatory surgical center, or other health care provider
462	462		or facility licensed and certified by the state;
463	463		2. A copy of the assignment has been provided by the
464	464		practitioner, hospital, home care agency , or ambulatory surgical
465	465
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516	516		center, or other health care provider or facility licensed and
517	517		certified by the state to the insurer;
518	518		3. A claim has been submitted by the practitioner, hospital,
519	519		home care agency, or ambulatory surgical center, or other health
520	520		care provider or facility licensed and certified by the state to the
521	521		insurer on a uniform health insu rance claim form adopted by the
522	522		Insurance Commissioner pursuant to Section 6581 of this title; and
523	523		4. A copy of the claim has been provided by the practitioner,
524	524		hospital, home care agency , or ambulatory surgical center , or other
525	525		health care provider or fa cility licensed and certified by the state
526	526		to the insured.
527	527		G. When any covered health care b enefits are assigned to an
528	528		out-of-network practitioner who, or a hospital, home care agency,
529	529		ambulatory surgical center, or other health ca re provider or
530	530		facility licensed or certified by the state that, has met all
531	531		conditions for compensation required by subsection F o f this
532	532		section, an insurer that fails to compensate the practitioner,
533	533		hospital, home care agency, a mbulatory surgical center, or o ther
534	534		health care provider or facility shall be liable for actual damag es,
535	535		any interest charges, court costs , or other legal fees, if
536	536		applicable. For any violation of this paragraph, the Insurance
537	537		Commissioner may, after notice and hearing, subject an insurer to an
538	538		additional civil fine in an amount to be determined by the
539	539		Commissioner within fifteen (15) days of a hearin g in which a
540	540
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590	590
591	591		violation is found. The fine shall be deposited into the State
592	592		Insurance Commissioner Revolving Fund.
593	593		H. The provisions of subsection F of this section shall not
594	594		apply to:
595	595		1. Any preferred pro vider organization (PPO), as defined by
596	596		generally accepted industry standards, that contracts with
597	597		practitioners that agree to accept the reimbursement available under
598	598		the PPO agreement as payment in full and agree not to balance bill
599	599		the insured; or
600	600		2. Any statewide provider network which:
601	601		a. provides that a practitioner who, or a hospital, home
602	602		care agency, or ambulatory surgical center , or other
603	603		health care provider or facility licensed or certified
604	604		by the state who that, joins the provider network
605	605		shall be compensated dire ctly by the insurer,
606	606		b. does not have any terms or conditions which have the
607	607		effect of discriminating against a particular class of
608	608		practitioner,
609	609		c. allows any practitioner, hospital, home care agency,
610	610		or ambulatory surgical center , or other health care
611	611		provider or facility licensed or certified by the
612	612		state except a practitioner who has a prior felony
613	613		conviction, to become a network provider if said
614	614		hospital or practitioner is willing to comply with the
615	615
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666	666		terms and conditions of a standa rd network provider
667	667		contract, and
668	668		d. contracts with practitioners that agree to accept the
669	669		reimbursement available under the network agreement as
670	670		payment in full and agree not to balance bill the
671	671		insured.
672	672		The provisions of this section shall not be construed to
673	673		prohibit a policyholder from assigning benefits available pursuant
674	674		to an accident and health insurance policy ; provided, however, that
675	675		the benefits of such policy include out -of-network provisions and
676	676		are being assigned to an out-out-network practitioner, hospital,
677	677		home care agency, ambulatory surgical center, or ot her health care
678	678		provider or facility licensed or certified b y the state. The
679	679		assignability of an accident and health insurance policy related to
680	680		the out-of-network care shall only be subj ect to the terms and
681	681		conditions specified in subsection F of this section.
682	682		H. I. A nonparticipating practitioner, hospital or, home care
683	683		agency, ambulatory surgical center , or other health care provider or
684	684		facility licensed or certified by the s tate may request from an
685	685		insurer and the insurer shall supply a good -faith estimate of the
686	686		allowable fee for a pr ocedure to be performed upon an insured based
687	687		upon information regarding the anticipated medical needs of the
688	688		insured provided to the insurer by the nonpa rticipating
689	689		practitioner.
690	690
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719	719		4
720	720		5
721	721		6
722	722		7
723	723		8
724	724		9
725	725		10
726	726		11
727	727		12
728	728		13
729	729		14
730	730		15
731	731		16
732	732		17
733	733		18
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735	735		20
736	736		21
737	737		22
738	738		23
739	739		24
740	740
741	741		I. J. A practitioner shall be equally c ompensated for covered
742	742		services and procedures provided to an insured on the basis of
743	743		charges prevailing in the same geographica l area or in similar sized
744	744		communities for similar services an d procedures provided to
745	745		similarly ill or injured persons regardle ss of the branch of the
746	746		healing arts to which the practitioner may belong, if:
747	747		1. The practitioner does not authorize or permit false and
748	748		fraudulent advertising regarding the services and p rocedures
749	749		provided by the pract itioner; and
750	750		2. The practitioner d oes not aid or abet the insured to viol ate
751	751		the terms of the policy.
752	752		J. K. Nothing in the Health Care Freedom of Choice Act shall
753	753		prohibit an insurer from establishing a preferred provider
754	754		organization and a standard part icipating provider contract
755	755		therefor, specifying the terms and conditions, including, but not
756	756		limited to, provider qualifications, and alternative levels or
757	757		methods of payment that must be met by a practitioner selected by
758	758		the insurer as a participating pr eferred provider organization
759	759		provider.
760	760		K. L. A preferred provider organi zation, in executing a
761	761		contract, shall not, by the terms and conditions of the contract or
762	762		internal protocol, discriminate within its network of practi tioners
763	763		with respect to partici pation and reimbursement as it rela tes to any
764	764
765	765
766	766		Req. No. 1576 Page 11 1
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768	768		3
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796	796		7
797	797		8
798	798		9
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804	804		15
805	805		16
806	806		17
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810	810		21
811	811		22
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814	814
815	815		practitioner who is acting w ithin the scope of the practitioner ’s
816	816		license under the law solely on the basis of such license .
817	817		L. M. Decisions by an insurer or a preferred provider
818	818		organization (PPO) to authoriz e or deny coverage for an emergency
819	819		service shall be based on the patient presenting symptoms arising
820	820		from any injury, illness, or condition manifesting itself by acute
821	821		symptoms of sufficient severity, including severe pain, such that a
822	822		reasonable and prudent layperson could expect the abse nce of medical
823	823		attention to result in s erious:
824	824		1. Jeopardy to the health of the patient;
825	825		2. Impairment of bodily function; or
826	826		3. Dysfunction of any bodily organ or part.
827	827		M. N. An insurer or preferred provider organiza tion (PPO) shall
828	828		not deny an otherwise covered emergency service based sol ely upon
829	829		lack of notification to the insurer or PPO.
830	830		N. O. An insurer or a preferred provider organ ization (PPO)
831	831		shall compensate a provider for patie nt screening, evaluation, and
832	832		examination services that are reason ably calculated to assist the
833	833		provider in determining whether the condition of the patient
834	834		requires emergency service. If the provider det ermines that the
835	835		patient does not require emergency service, coverage for services
836	836		rendered subsequent to that determ ination shall be governed by the
837	837		policy or PPO contract.
838	838
839	839
840	840		Req. No. 1576 Page 12 1
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888	888
889	889		O. P. Nothing in this act the Health Care Freedom of Choice Act
890	890		shall be construed as prohibiting an insurer, preferred provid er
891	891		organization or other network from determining the adequacy of the
892	892		size of its network.
893	893		P. Q. An insurer or a preferred provider organization shall not
894	894		unilaterally remove a provider from the network solely because the
895	895		provider informs an enrollee of the full range of physicians and
896	896		providers available to the enrollee, inc luding out-of-network
897	897		providers. Nothing in this act the Health Care Freedom of Cho ice
898	898		Act prohibits any insurer from allowing a contract to expire by its
899	899		own terms or negotiating a new con tract with the provider at the end
900	900		of the contract term. A provider agreement shall not, as a
901	901		condition of the agreement, prohibit, penalize, terminate, or
902	902		otherwise restrict a preferred provider from ref erring to an out-of-
903	903		network provider; provided, the insured signs an acknowledgmen t of
904	904		referral that the insured may be responsible for:
905	905		1. Higher coinsurance and deductibles; and
906	906		2. Charges which exceed the allowable charges of a preferred
907	907		provider.
908	908		SECTION 3. This act shall become effe ctive November 1, 2023.
909	909
910	910		59-1-1576 RD 1/13/2023 4:57:00 PM