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HOUSE OF REPRESENTATIVES - FLOOR VERSION
STATE OF OKLAHOMA
1st Session of the 60th Legislature (2025)
COMMITTEE SUBSTITUTE
FOR
HOUSE BILL NO. 1853 By: Schreiber, Lepak, and Sneed
of the House
and
Frix of the Senate
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, coinsuranc e, 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:
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1. "Health care service" means any services provided by a
health care provider, or by an i ndividual 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.
The term also includes the provision of mental health and
substance use disorder 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 i nclude 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 inde mnity 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 "h ealth benefit plan" shall not include:
a. a plan that provides coverage:
(1) only for a specified disease or diseases or under
an individual limited benefit policy,
(2) only for accidental death or dismemberment,
(3) only for dental or vision care,
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(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
Statutes, that provides coverage to members of the
state Medicaid program,
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:
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A. An enrollee may choose to pay for a health care service out -
of-pocket from a licensed health care provider. If an e nrollee
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
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 enrol lee 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 the
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 ag ainst
the carrier for payment for the health care service
provided to the enrollee or patient; and
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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 balanc e 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
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 allowe d 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
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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.
COMMITTEE REPORT BY: COMMITTEE ON COMMERCE AND ECONOMIC DEVELOPMENT
OVERSIGHT, dated 03/10/2025 - DO PASS, As Amended and Coauthored.