Bill > SB1048

This bill modifies the Oklahoma Right to Shop Act by requiring insurance carriers to establish a shared savings incentive program, rather than making it optional. The bill introduces a new definition for "average allowed amount" as the mean of all allowed amounts paid for a comparable health care service. Insurance carriers must now offer incentives to enrollees who choose health care services from providers charging less than the average allowed amount. The bill mandates that carriers calculate incentives as a percentage of the savings generated, with the incentive being at least 25% of the difference between the average allowed amount and the actual service cost. Carriers must publish a list of comparable services and incentive amounts, notify enrollees about the program annually, and provide incentive payments at least quarterly. The bill also adds protections for enrollees receiving out-of-network services, ensuring their financial liability remains consistent with in-network rates. Additionally, carriers must submit an annual report to the Insurance Department detailing program participation, service costs, and incentive payments. The changes aim to encourage cost-conscious healthcare choices by providing financial incentives to enrollees who seek more affordable medical services. The bill will become effective on November 1, 2025.

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http://www.oklegislature.gov/BillInfo.aspx?Bill=sb1048&Session=2600