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28	28	STATE OF OKLAHOMA
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30	30	1st Session of the 60th Legislature (2025)
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32	32	HOUSE BILL 1119 By: Lepak
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38	38	AS INTRODUCED
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40	40	An Act relating to Oklahoma Right to Shop Act;
41	41	amending Section 2, Chapter 151, O.S.L. 2022 (36 O.S.
42	42	Supp. 2024, Section 6060.41), which r elates to
43	43	definitions; adding a term; modifying certain terms;
44	44	amending Section 3, Chapter 151, O.S.L. 2022 (36 O.S.
45	45	Supp. 2024, Section 6060.42), which relates to shared
46	46	savings incentive program and insurance carrier
47	47	obligations; clarifying the shared sa vings incentive
48	48	program; and providing an effective date .
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54	54	BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
55	55	SECTION 1. AMENDATORY Section 2, Chapter 151, O.S.L.
56	56	2022 (36 O.S. Supp. 2024, Section 6060.41), is amende d to read as
57	57	follows:
58	58	Section 6060.41. As used in the Oklahoma Right to Shop Act:
59	59	1. "Allowed amount" means the contractually agreed -upon amount
60	60	paid by a carrier to a health care entity participating in the
61	61	network of the carrier;
62	62	2. "Average allowed amount" means the mean of all allowed
63	63	amounts paid for a comparable health care service;
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90	90	3. "Comparable health care service " means any covered
91	91	nonemergency health care service or bundle of services. The
92	92	Insurance Commissioner may limit what is considered a comparable
93	93	health care service if an insurance carrier can demonstrate allowed
94	94	amount variation among network providers is less than Fifty Dollars
95	95	($50.00);
96	96	3. 4. "Health benefit plan" means any plan as defined in
97	97	subsection C of Section 6060.4 of Title 36 of the Oklahoma Statutes;
98	98	4. 5. "Insurance carrier" or "carrier" means an insurance
99	99	company that issues policies of accident and health insurance and is
100	100	licensed to sell insurance in this state;
101	101	5. 6. "Shared savings incentive " means a voluntary and optional
102	102	financial incentive that an insurance carrier may shall provide to
103	103	an enrollee for choosing certain health care services under a shared
104	104	savings incentive program; and
105	105	6. 7. "Shared savings incentive program " means a voluntary and
106	106	optional an incentive program established by an insurance carrier
107	107	pursuant to this act.
108	108	SECTION 2. AMENDATORY Section 3, Chapter 151, O.S.L.
109	109	2022 (36 O.S. Supp. 2024, Section 6060.42), is amended to read as
110	110	follows:
111	111	Section 6060.42. A. An insurance carrier may shall offer a
112	112	shared savings incentive program to provide incentives to an
113	113	enrollee when the enrollee obtains a comparable health care service
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140	140	that is covered by the carrier from providers that charge less than
141	141	the average allowed amount p aid by that carrier to network providers
142	142	for that, comparable health care serv ice. If a provider's allowed
143	143	amount is less than the average allowed amount paid by the carrier,
144	144	the provider shall not participate in the shared savings inventive
145	145	program unless the provider agrees to accept an amount less than the
146	146	allowed amount.
147	147	B. If an enrollee of a health benefit plan elects to receive a
148	148	covered comparable health care service from a provider who is not
149	149	participating in the carriers network and agrees to ac cept an amount
150	150	less than the average allowed amount, the carrier shall ensure that:
151	151	1. The enrollee's financial liability is no greater than the
152	152	in-network deductible, copay, and coinsurance amounts as dictated in
153	153	the health benefit plan contract; and
154	154	2. Calculation of coinsurance liability is based on the amount
155	155	negotiated by the enrollee and their provider so long as it is an
156	156	amount less than the average allowed amount.
157	157	C. Incentives may shall be calculated as a percentage of the
158	158	difference in allowed amounts to the average , as a flat dollar
159	159	amount, or by any other reasonable me thodology approved by the
160	160	Insurance Department allowed amount paid by a carrier for a
161	161	comparable health care service . If an enrollee elected to receive a
162	162	covered comparable heal th care service from a provider who is not
163	163	participating in the carriers network, the incentive shall be
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190	190	calculated as a percentage of the difference in average allowed
191	191	amount to the amount agreed upon between the enrollee and provider,
192	192	so long as the amount is less than the average allowed amount . The
193	193	carrier shall provide the inc entive as a cash payment to the
194	194	enrollee or credit toward the annual in -network deductible and out -
195	195	of-pocket limit of the enrollee. Carriers may allow enrollees to
196	196	select which method the enrollee prefers to receive the incentive.
197	197	C. D. An insurance carrier that offers a shared savings
198	198	incentive program shall:
199	199	1. Establish the program as a component part of the policy or
200	200	certificate of insurance provided by the carrier and noti fy the
201	201	enrollees and the Insurance Department at least thirty (30) days
202	202	before program termination;
203	203	2. File a description of the program on a form prescribed by
204	204	the Insurance Commissioner. The Insurance Department shall review
205	205	the filing and determine wh ether the program complies with the
206	206	provisions of this section;
207	207	3. Notify an enrollee, annually or at the time of renewal, of
208	208	the availability of the shared savings incentive program and the
209	209	procedures to participate in the program;
210	210	4. Publish on the web site of the insurance carrier, easily
211	211	accessible to enrollees and applicants f or insurance, a list of
212	212	comparable health care services and health care providers and the
213	213	shared savings incentive amount applicable for each service. A
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240	240	shared savings incentive shall not be less than twenty -five percent
241	241	(25%) of the savings generated by the participation of the enrollee
242	242	in any shared savings incentive program offered by the insurance
243	243	carrier. The baseline for the savings calculation shall be the
244	244	average in-network amount paid for that service in the most recent
245	245	twelve-month period or any other methodology established by the
246	246	insurance carrier and approved by the Insurance Department ;
247	247	5. Upon request by an enrollee, provide the average allowed
248	248	amount for a covered comparable health care service;
249	249	6. At least quarterly, credit , deposit or make a cash payment
250	250	to an enrollee of the shared savings incentive amount pursuant to
251	251	participation in the shared savings incentive program; and
252	252	6. 7. Submit an annual report to the Insurance Department
253	253	within ninety (90) days after the close of each healt h benefit plan
254	254	year. At a minimum, the report shall include the following
255	255	information:
256	256	a. the number of enrollees who participated in the
257	257	program during the health benefit plan year and the
258	258	number of instances of participation,
259	259	b. the total cost of services provided as a part of the
260	260	program, and
261	261	c. the total value of the shared savings incentive
262	262	payments made to enrollees participating in the
263	263	program and the values distributed as cash or credit
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290	290	toward the annual in -network deductible and out -of-
291	291	pocket limit of an enrollee.
292	292	D. An enrollee shall not be required to participate in a shared
293	293	savings incentive program.
294	294	SECTION 3. This act shall become effective November 1, 2025.
295	295
296	296	60-1-10624 TJ 12/05/24

Oklahoma 2025 Regular Session

Oklahoma House Bill HB1119 Compare Versions