Bill > SB515

This bill introduces new provisions for health insurance in Oklahoma that allow enrollees more flexibility in paying for healthcare services. The bill defines key terms like "health benefit plan" (which includes various types of health insurance but excludes specialized or limited coverage plans) and "health care service" (medical services related to diagnosis, treatment, and care). Under the new law, enrollees can choose to pay out of pocket for a health care service if they negotiate a lower price than the average allowed amount by their health benefit plan. After receiving the service, the enrollee can electronically submit documentation to their insurance carrier, including details about the service, provider, and the negotiated cost. The health care provider must accept the enrollee's payment as payment in full and cannot bill the enrollee or insurance plan for any additional balance. If the health care service is covered under the enrollee's plan, the insurance carrier must count the full out-of-pocket amount toward the enrollee's deductible and annual maximum out-of-pocket expense, with the amount attributed to either in-network or out-of-network deductibles depending on the provider. The bill specifies that the counted amount cannot exceed the total out-of-pocket requirement for the contract period and will not carry over to a new contract period. The legislation is set to become effective on November 1, 2025.

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http://www.oklegislature.gov/BillInfo.aspx?Bill=sb515&Session=2600