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STATE OF OKLAHOMA
1st Session of the 59th Legislature (2023)
SENATE BILL 912 By: Seifried
AS INTRODUCED
An Act relating to the Oklahoma Right to Shop Act;
amending Section 2, Chapter 151, O.S.L. 2022 and
Section 3, Chapter 151, O.S.L. 2022 (36 O.S. Supp.
2022, Sections 6060.41 and 6060.42), which relate to
definitions and shared savings incent ive program;
defining term; establishing provisions of program;
conforming language; updating statutory reference;
providing for codification; and pro viding an
effective date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY Section 2, Chapter 151, O.S.L .
2022 (36 O.S. Supp. 2022 , Section 6060.41), is amended to read as
follows:
Section 6060.41. As used in the Oklahoma Right to Shop Act:
1. “Allowed amount” means the contractually agreed-upon amount
paid by a carrier to a health care enti ty participating in the
network of the carrier;
2. “Comparable health care service” means any covered
nonemergency health care service or bundle of services. The
Insurance Commissioner may li mit what is considered a comparable
health care service if an i nsurance carrier can demonstrate allowed
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amount variation among network providers is less than Fifty Dollars
($50.00);
3. “Health benefit plan” means any plan as defined in
subsection C of Section 6060.4 of Title 36 of the Oklahoma Statutes
this title;
4. “Health care entity” means a physician, hospital,
pharmaceutical company, pharmacist, laboratory, or other provider of
health care services that is licensed in this state;
5. “Insurance carrier” or “carrier” means an insurance company
that issues policies of accident and health insurance and is
licensed to sell insurance in this state;
5. 6. “Shared savings incentive” means a voluntary and optional
financial incentive that an insurance ca rrier may provide to an
enrollee for choosing certain h ealth care services under a shared
savings incentive program; and
6. 7. “Shared savings incentive program ” or “program” means a
voluntary and optional in centive program established by an insura nce
carrier pursuant to this act.
SECTION 2. AMENDATORY Section 3, Chapte r 151, O.S.L.
2022 (36 O.S. Supp. 2022, Section 6060.42), is amended to read as
follows:
Section 6060.42. A. An insurance carrier, offering a health
benefit plan in this state in the individual or group insurance
market, except plans w here enrollees receive a premium subsidy under
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the federal Patient Protection and Affordable Car e Act, may offer a
shared savings incentive program to provide incentives to an
enrollee when the enrollee obtains a comparable health care service
that is covered by the carrier from providers that charge less than
the average allowed amount paid by that carrier to network providers
for that, comparable health care service .
B. Incentives may be calculated as a percentage of the
difference in allowed amounts to the average, as a flat dollar
amount, or by any other reasonable methodology approved by the
Insurance Department. The carrier shall provide the incentive as a
cash payment to the enrollee or credit toward the annual in-network
deductible and out-of-pocket limit of the enrollee. Carriers may
allow enrollees to select which method the enrollee prefers to
receive the incentive.
C. An insurance carrier that offers a shared s avings incentive
program shall:
1. Establish the program as a component part of the policy or
certificate of insurance provided by the carrier and notify the
enrollees and the Insurance Department at least thirty (30) days
before program termination ;
2. File a description of the program on a form prescribed by
the Insurance Commissio ner. The Insurance Department s hall review
the filing and determine whether the program complies with the
provisions of this section;
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3. Notify an enrollee, annually or at the time of renewal, of
the availability of the shared savings incentive program a nd the
procedures to participate in the program;
4. Publish on the website of the insurance carrier, easily
accessible to enrollees and applicants for insurance, a list o f
comparable health care services and health care providers and the
shared savings incentive amount applicable for ea ch service. A
shared savings incentive shall not be less than twenty-five percent
(25%) of the savings generated by the participation of the enrollee
in any shared savings incentive program offered by the insurance
carrier. The baseline for the savings c alculation shall be the
average in-network amount paid for that service in the most recent
twelve-month period or any other methodology est ablished by the
insurance carrier and approved by the Insurance Department;
5. At least quarterly, credit, deposit o r make a cash payment
to an enrollee of the shared savings incentive amount pursuant to
participation in the shared savings incentive prog ram; and
6. Submit an annual report to the Insurance Department within
ninety (90) days after the close of each health benefit plan year.
At a minimum, the report shall include the following information:
a. the number of enrollees who participated in t he
program during the health benefit plan year and the
number of instances of participat ion,
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b. the total cost of servic es provided as a part of the
program, and
c. the total value of the shared savings incentive
payments made to enrollees participating in the
program and the values distributed as cash or credit
toward the annual in-network deductible and out-of-
pocket limit of an enrollee.
D. An enrollee shall not be required to participate in a shared
savings incentive program.
SECTION 3. This act shall become effective November 1, 2023.
59-1-1577 RD 1/19/2023 10:36:03 AM