Oklahoma 2025 2025 Regular Session

Oklahoma House Bill HB1853 Comm Sub / Bill

Filed 03/10/2025

                     
 
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STATE OF OKLAHOMA 
 
1st Session of the 60th Legislature (2025) 
 
COMMITTEE SUBSTITUTE 
FOR 
HOUSE BILL NO. 1853 	By: Schreiber 
 
 
 
 
 
COMMITTEE SUBSTITUTE 
 
An Act relating to medical expenses; defining terms; 
authorizing individuals to pay for medical expenses 
out-of-pocket; directing insurance providers to count 
certain payments toward deductibles, coinsurance, and 
copayments; providing for documentation requirements; 
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: 
As used in this section: 
1.  "Health care service" means any services provided by a 
health care provider, or by an individual working for or under the 
supervision of a health care provider, that relate to the diagnosis, 
assessment, prevention, treatment, or care of any human illness, 
disease, injury, or condition, as defined by paragraph 2 of Section 
1-1708.1C of Title 63 of the Oklahoma Statutes .   
 
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The term also includes the provision of mental health and 
substance use disord er services, as defined by Section 6060.10 of 
Title 36 of the Oklahoma Statutes , and the provision of durable 
medical equipment.  The term does not include the provision, 
administration, or prescription of pharmaceutical products or 
services; and 
2.  "Health benefit plan" means group hospital coverage, 
individual and group medical insurance coverage, a not -for-profit 
hospital or medical service or indemnity plan, a prepaid health 
plan, a health maintenance organization plan, a preferred provider 
organization plan, the State and Education Employees Group Health 
Insurance Plan, and coverage provided by a Multiple Employer Welfare 
Arrangement.  The term "health benefit plan" shall not include: 
a. a plan that provides coverage: 
(1) only for a specified disease o r diseases or under 
an individual limited benefit policy, 
(2) only for accidental death or dismemberment, 
(3) only for dental or vision care, 
(4) a hospital confinement indemnity policy, 
(5) disability income insurance or a combination of 
accident-only and disability income insurance, or 
(6) as a supplement to liability insurance, 
b. any health plan offered by a contracted entity, as 
defined in Section 4002.2 of Title 56 of the Oklahoma   
 
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Statutes, that provides coverage to members of the 
state Medicaid progr am, 
c. a Medicare supplemental policy as defined by Section 
1882(g)(1) of the Social Security Act (42 U.S.C., 
Section 1395ss), 
d. workers' compensation insurance coverage, 
e. medical payment insurance issued as part of a motor 
vehicle insurance policy, 
f. a long-term care policy, including a nursing home 
fixed indemnity policy, unless a determination is made 
that the policy provides benefit coverage so 
comprehensive that the policy meets the definition of 
a health benefit plan, or 
g. short-term health insurance issued on a nonrenewable 
basis with a duration of six (6) months or less. 
SECTION 2.     NEW LAW     A new section of law to be codified 
in the Oklahoma Statutes as Section 6060.51 of Title 36, unless 
there is created a duplication in numbering, reads as follows: 
A.  An enrollee may choose to pay for a health care service out -
of-pocket from a licensed health care provider.  If an enrollee 
obtains a medically necessary health care service covered by the 
enrollee's health benefit plan and negotiates for a lower price from 
a licensed health care provider than the average allowed amount 
established by the enrollee's health benefits plan for the covered   
 
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health care service, and the enrollee pays for the health care 
service out-of-pocket, the enrollee may send documentation, which 
may be sent electronically, to the carrier, that provides the 
following: 
1.  The health care service the enrollee or patient received and 
the licensed health care provider 's name and contact information; 
2.  If a health care provider's order is required by the 
enrollee's policy, the order from the health care provider given to 
the enrollee or patient and the final bill or statement for the 
health care service;  
3.  The negotiated cost of the health care service that th e 
enrollee received: 
a. the enrollee paid out -of-pocket for the health care 
services received, and 
b. the health care entity is not making a claim against 
the carrier for payment for the health care service 
provided to the enrollee or patient ; and 
4.  The health care provider shall accept the enrollee's payment 
as payment in full and shall not bill the enrollee or the health 
benefit plan for any balance between the amount collected from the 
enrollee and the provider's billed charge for the service. 
B.  A carrier that receives the documentation described in 
subsection A of this section shall count the full amount that the   
 
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enrollee paid out-of-pocket toward the enrollee 's deductible, and 
annual maximum out-of-pocket expense: 
1.  If the health care service is covered under the enrollee's 
health benefit plan; and 
2.  The enrollee negotiated for a lower cost for the health care 
service than the average allowed amount established by the 
enrollee's health benefit plan for that covered health care service. 
C. The amount of the enrollee's out -of-pocket cost shall be 
attributed to the in -network deductible, and annual maximum out -of-
pocket expense, if the provider was an in -network provider, and to 
the out-of-network deductible, and annual maximum out -of-pocket 
expense if the provider was an out-of-network provider. 
D. The amount counted toward an enrollee 's applicable out-of-
pocket deductible, and annual maximum out -of-pocket expense shall 
not exceed the total amount that the enrollee is required to pay 
out-of-pocket during a contractually agreed upon period of time for 
health care services that are included under the covered person 's 
insurance plan, and does not carry over once a new contract or 
agreement period for the insurance plan begins. 
SECTION 3.  This act shall become effective November 1, 2025. 
 
60-1-13298 TKR 03/06/25