Shown verbatim: the complete text as captured from the official PDF posted by the Oklahoma Legislature, fetched 2026-07-23. Page and line markers are part of the official record; nothing is edited or removed. The official bill page.
1 STATE OF OKLAHOMA
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2 1st Session of the 60th Legislature (2025)
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3 SENATE BILL 1048 By: Bullard
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6 AS INTRODUCED
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7 An Act relating to shared savings incentive program;
7 amending Sections 2 and 3, Chapter 151, O.S.L. 2022
8 (36 O.S. Supp. 2024, Sections 6060.41 and 6060.42);
8 modifying definitions; requiring insurance carriers
9 to offer certain programs; modifying average allowed
9 amounts; modifying incentive calculations; requiring
10 carriers to provide certain information upon request;
10 updating statutory reference; and providing an
11 effective date.
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14 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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15 SECTION 1. AMENDATORY Section 2, Chapter 151, O.S.L.
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16 2022 (36 O.S. Supp. 2024, Section 6060.41), is amended to read as
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17 follows:
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18 Section 6060.41. As used in the Oklahoma Right to Shop Act:
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19 1. "Allowed amount" means the contractually agreed-upon amount
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20 paid by a carrier to a health care entity participating in the
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21 network of the carrier;
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22 2. "Average allowed amount" means the mean of all allowed
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23 amounts paid for a comparable health care service;
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1 3. "Comparable health care service" means any covered
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2 nonemergency health care service or bundle of services. The
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3 Insurance Commissioner may limit what is considered a comparable
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4 health care service if an insurance carrier can demonstrate allowed
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5 amount variation among network providers is less than Fifty Dollars
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6 ($50.00);
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7 3. 4. "Health benefit plan" means any plan as defined in
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8 subsection C of Section 6060.4 of Title 36 of the Oklahoma Statutes;
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9 4. 5. "Insurance carrier" or "carrier" means an insurance
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10 company that issues policies of accident and health insurance and is
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11 licensed to sell insurance in this state;
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12 5. 6. "Shared savings incentive" means a voluntary and optional
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13 financial incentive that an insurance carrier may shall provide to
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14 an enrollee for choosing certain health care services under a shared
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15 savings incentive program; and
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16 6. 7. "Shared savings incentive program" means a voluntary and
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17 optional an incentive program established by an insurance carrier
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18 pursuant to this act the Oklahoma Right to Shop Act.
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19 SECTION 2. AMENDATORY Section 3, Chapter 151, O.S.L.
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20 2022 (36 O.S. Supp. 2024, Section 6060.42), is amended to read as
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21 follows:
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22 Section 6060.42. A. An insurance carrier may shall offer a
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23 shared savings incentive program to provide incentives to an
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24 enrollee when the enrollee obtains a comparable health care service
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Req. No. 543 Page 2
1 that is covered by the carrier from providers that charge less than
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2 the average allowed amount paid by that carrier to network providers
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3 for that, comparable health care service. If a provider's allowed
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4 amount is less than the average allowed amount paid by the carrier,
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5 the provider shall not participate in the shared savings incentive
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6 program unless the provider agrees to accept an amount less than the
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7 allowed amount.
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8 B. If an enrollee of a health benefit plan elects to receive a
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9 covered comparable health care service from a provider who is not
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10 participating in the carrier's network and agrees to accept an
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11 amount less than the average allowed amount, the carrier shall
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12 ensure that:
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13 1. The enrollee's financial liability is no greater than the
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14 in-network deductible, copay, and coinsurance amounts as dictated in
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15 the health benefit plan contract; and
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16 2. Calculation of coinsurance liability is based on the amount
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17 negotiated by the enrollee and his or her provider as long as the
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18 calculated amount is less than the average allowed amount.
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19 C. Incentives may shall be calculated as a percentage of the
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20 difference in allowed amounts to the average, as a flat dollar
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21 amount, or by any other reasonable methodology approved by the
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22 Insurance Department allowed amount paid by a carrier for a
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23 comparable health care service. If an enrollee elected to receive a
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24 covered comparable health care service from a provider who is not
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1 participating in the carrier's network, the incentive shall be
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2 calculated as a percentage of the difference in average allowed
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3 amount to the amount agreed upon between the enrollee and provider,
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4 as long as the amount is less than the average allowed amount. The
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5 carrier shall provide the incentive as a cash payment to the
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6 enrollee or credit toward the annual in-network deductible and out-
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7 of-pocket limit of the enrollee. Carriers may allow enrollees to
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8 select which method the enrollee prefers to receive the incentive.
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9 C. D. An insurance carrier that offers a shared savings
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10 incentive program shall:
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11 1. Establish the program as a component part of the policy or
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12 certificate of insurance provided by the carrier and notify the
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13 enrollees and the Insurance Department at least thirty (30) days
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14 before program termination;
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15 2. File a description of the program on a form prescribed by
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16 the Insurance Commissioner. The Insurance Department shall review
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17 the filing and determine whether the program complies with the
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18 provisions of this section;
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19 3. Notify an enrollee, annually or at the time of renewal, of
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20 the availability of the shared savings incentive program and the
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21 procedures to participate in the program;
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22 4. Publish on the website of the insurance carrier, easily
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23 accessible to enrollees and applicants for insurance, a list of
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24 comparable health care services and health care providers and the
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1 shared savings incentive amount applicable for each service. A
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2 shared savings incentive shall not be less than twenty-five percent
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3 (25%) of the savings generated by the participation of the enrollee
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4 in any shared savings incentive program offered by the insurance
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5 carrier. The baseline for the savings calculation shall be the
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6 average in-network amount paid for that service in the most recent
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7 twelve-month period or any other methodology established by the
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8 insurance carrier and approved by the Insurance Department;
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9 5. Upon request by an enrollee, provide the average allowed
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10 amount for a covered comparable health care service;
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11 6. At least quarterly, make a credit, deposit or make a cash
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12 payment to an enrollee of the shared savings incentive amount
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13 pursuant to participation in the shared savings incentive program;
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14 and
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15 6. 7. Submit an annual report to the Insurance Department
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16 within ninety (90) days after the close of each health benefit plan
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17 year. At a minimum, the report shall include the following
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18 information:
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19 a. the number of enrollees who participated in the
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20 program during the health benefit plan year and the
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21 number of instances of participation,
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22 b. the total cost of services provided as a part of the
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23 program, and
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1 c. the total value of the shared savings incentive
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2 payments made to enrollees participating in the
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3 program and the values distributed as cash or credit
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4 toward the annual in-network deductible and out-of-
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5 pocket limit of an enrollee.
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6 D. E. An enrollee shall not be required to participate in a
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7 shared savings incentive program.
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8 SECTION 3. This act shall become effective November 1, 2025.
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Req. No. 543 Page 6Every fact on this page links to its source, starting with the official bill record.