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
1
2 2nd Session of the 60th Legislature (2026)
2
3 SENATE BILL 2129 By: Bullard
3
4
4
5
5
6 AS INTRODUCED
6
7 An Act relating to health insurance; creating the
7 Employer Health Plan Transparency Act; providing
8 short title; defining terms; prohibiting certain
8 health plan from entering into certain contract;
9 prohibiting certain contract provisions from limiting
9 or denying certain information; prohibiting certain
10 contracts from containing certain provisions;
10 prohibiting certain contracts from prohibiting or
11 penalizing certain health plans in certain
11 situations; requiring certain contracts in violation
12 of certain provisions to be void; requiring certain
12 insurer or provider to provide certain information
13 consistent with certain Health Insurance Portability
13 and Accountability Act of 1996 (HIPAA) requirements;
14 requiring certain health plan to comply with certain
14 HIPAA requirements; construing provisions; requiring
15 certain claims to be made in accordance with certain
15 regulations; requiring certain information to be
16 unmodified; requiring certain notices to be in
16 certain formats; requiring certain disclosures by
17 certain issuers or providers; requiring itemization
17 of certain costs; requiring certain supports;
18 requiring submission of certain annual declaration;
18 requiring certain submission in certain situations;
19 allowing Insurance Commissioner to asses certain
19 civil penalties; allowing Commissioner to issue
20 certain orders; allowing certain action against
20 license in certain situations; prohibiting certain
21 issuer or provider from retaliating against certain
21 persons; requiring Commissioner to promulgate rules
22 and regulations; providing for noncodification;
22 providing for codification; and providing an
23 effective date.
23
24
24
Req. No. 3216 Page 1
1
1
2 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
2
3 SECTION 1. NEW LAW A new section of law not to be
3
4 codified in the Oklahoma Statutes reads as follows:
4
5 This act shall be known as and may be cited as the "Employer
5
6 Health Plan Transparency Act".
6
7 SECTION 2. NEW LAW A new section of law to be codified
7
8 in the Oklahoma Statutes as Section 5410 of Title 36, unless there
8
9 is created a duplication in numbering, reads as follows:
9
10 As used in this act:
10
11 1. "Auditable material" means claims and encounter information
11
12 or data and any documentation supporting claim payments, including
12
13 medical records;
13
14 2. "Claims and encounter information or data" means all
14
15 documents, including electronically stored information containing
15
16 claim files, encounter data, remittance and electronic funds
16
17 transfer files, medical records supporting payment information,
17
18 policy and contract documents, and all documents or electronically
18
19 stored information containing information pursuant to 29 U.S.C.,
19
20 Section 1185m(a)(1)(B);
20
21 3. "Covered service provider" means a service provider that
21
22 enters into a contract with a regulated health plan and reasonably
22
23 expects One Thousand Dollars ($1,000.00) or more in compensation to
23
24 be received in connection with providing, delivering, arranging for,
24
Req. No. 3216 Page 2
1 paying for, or reimbursing any of the costs of health care services
1
2 regardless of whether such services will be performed or
2
3 compensation received by the covered service provider, an affiliate,
3
4 or a subcontractor;
4
5 4. "Electronic funds transfer" means the electronic message a
5
6 health insurance issuer or covered service provider sends to a
6
7 financial institution to order the financial institution to
7
8 electronically transfer funds to a health care provider's account to
8
9 pay for health care services;
9
10 5. "Electronic remittance advice" means a digital document that
10
11 a health insurance issuer or covered service provider sends to a
11
12 health care provider that supplies information about the payment to
12
13 the health care provider, including any adjustments to claims and
13
14 other payments based on factors including, but not limited to, any
14
15 adjustments to claims or other payments based on factors such as
15
16 contractual agreements, patient benefit coverage, expected co-
16
17 payments or coinsurance, and capitation payments;
17
18 6. "Encounter data" means the information relating to the
18
19 receipt of any items or service by an enrollee under a contract
19
20 between an employee and a regulated health plan;
20
21 7. "Group health plan" means an employee welfare benefit plan
21
22 that provides medical care to employees or their dependents directly
22
23 or through insurance or reimbursement. Group health plan shall not
23
24 include Medicare supplement or accident only, fixed indemnity,
24
Req. No. 3216 Page 3
1 limited benefit, credit, dental, vision, specified disease, or
1
2 Tricare supplemental insurance, long-term care or disability income,
2
3 workers' compensation, or automobile medical payment insurance or
3
4 self-insured employee welfare benefit plan governed by the
4
5 provisions of 29 U.S.C., Section 1001 et seq.;
5
6 8. "Health care provider" means any person, group, professional
6
7 corporation, or other organization including, but not limited to,
7
8 medical clinics, medical groups, home health care agencies, health
8
9 infusion centers, urgent care centers, or emergency care centers
9
10 that are licensed or authorized in this state to furnish health care
10
11 services;
11
12 9. "Health care services" means health care related items,
12
13 products, or services rendered or furnished by a health care
13
14 provider within the scope of the provider's license, certification,
14
15 or legal authorization for the diagnosis, prevention, treatment,
15
16 cure, or relief of a health condition, illness, injury, or disease
16
17 including, but not limited to, durable medical equipment, infusion,
17
18 imaging, and hospital, medical, surgical, and pharmaceutical
18
19 services or products;
19
20 10. "Health insurance issuer" means any entity subject to the
20
21 insurance laws and regulations of this state or subject to the
21
22 jurisdiction of the Insurance Department that contracts or offers to
22
23 contract to provide, deliver, arrange for, pay for, or reimburse any
23
24 of the costs of health care services. Health insurance issuer shall
24
Req. No. 3216 Page 4
1 include a sickness and accident insurance company, health
1
2 maintenance organization, nonprofit hospital and health service
2
3 corporation, or other entity providing a plan of health insurance,
3
4 health benefits, or health services;
4
5 11. "HIPAA" means the Health Insurance Portability and
5
6 Accountability Act of 1996, P.L. No. 104-191, and all related
6
7 privacy and security regulations pursuant to the Social Security
7
8 Act, P.L. No. 74-271, 42 U.S.C., Section 1320d-9;
8
9 12. "Public employee health plan" means a governmental plan
9
10 pursuant to 29 U.S.C., Section 1002(32), which is sponsored by this
10
11 state or any political subdivision of this state, or a health
11
12 benefits program administered for the benefit of public employees or
12
13 eligible retirees;
13
14 13. "Regulated health plan" means a group health plan or a
14
15 public employee health plan as defined by this section; and
15
16 14. "Self-insured employee welfare benefit plan" means an
16
17 employee welfare plan where an employer assumes the financial risk
17
18 for providing health care benefits to its employees and such
18
19 arrangement shall be subject to the exclusive jurisdiction of the
19
20 Employee Retirement Income Security Act of 1974, 29 U.S.C., Section
20
21 1001 et seq.
21
22 SECTION 3. NEW LAW A new section of law to be codified
22
23 in the Oklahoma Statutes as Section 5411 of Title 36, unless there
23
24 is created a duplication in numbering, reads as follows:
24
Req. No. 3216 Page 5
1 A. A regulated health plan shall not enter into, extend, or
1
2 renew a contract with a health insurance issuer or covered service
2
3 provider to provide, deliver, arrange for, pay for, or reimburse any
3
4 of the costs of health care services to the regulated health plan's
4
5 employees or their dependents unless the contract or arrangement
5
6 provides the regulated health plan access to all claims and
6
7 encounter information or data, and all documentation supporting
7
8 claim payments, including medical records and policy documents
8
9 related to regulated health plan enrollee claims, are sufficient to
9
10 enable the regulated health plan to comply with applicable law and
10
11 plan terms and determine accuracy of payments.
11
12 B. No contract provision shall unreasonably:
12
13 1. Delay a regulated health plan from accessing all claims and
13
14 encounter information or data of its employees or their dependents,
14
15 and all documentation supporting claim payments related to regulated
15
16 health plan enrollee claims, including records and policy documents,
16
17 more than fifteen (15) days from the date of a request for such
17
18 information by a regulated health plan to a health insurance issuer;
18
19 2. Limit the volume of claims and encounter information or
19
20 data, and any documentation supporting claim payments of the
20
21 regulated health plan's employees or their dependents, including
21
22 medical records and policy documents related to regulated health
22
23 plan enrollee claims, which a regulated health plan may access
23
24
24
Req. No. 3216 Page 6
1 during an audit or pursuant to any request by a regulated health
1
2 plan to a health insurance issuer for such information or data;
2
3 3. Limit the disclosure of the payment arrangements of the
3
4 health insurance issuer to provide, arrange for, pay for, or
4
5 reimburse any of the costs of health care services to the regulated
5
6 health plan's employees or their dependents, including payment
6
7 calculations and formulas, quality measures, contract terms, payment
7
8 amounts, incentive measurement periods, and other payment
8
9 methodologies;
9
10 4. Limit a regulated health plan's right to select an auditor
10
11 to review auditable materials or limit audit frequency to less than
11
12 once per month;
12
13 5. Limit a regulated health plan from accessing claims and
13
14 encounter information or data;
14
15 6. Limit disclosure of fees charged to a regulated health plan
15
16 related to administration or claims processing, including
16
17 renegotiation fees or repricing fees;
17
18 7. Limit disclosure of information related to overpayments; or
18
19 8. Limit public disclosure of de-identified or aggregate
19
20 information that a regulated health plan receives from a health
20
21 insurance issuer or covered service provider under this act.
21
22 C. No contract between a health insurance issuer or covered
22
23 service provider and a regulated health plan shall:
23
24
24
Req. No. 3216 Page 7
1 1. Contain any provision that unreasonably delays or limits a
1
2 regulated health plan's access to claims and encounter information
2
3 or data; or
3
4 2. Not prohibit or penalize a regulated health plan for making
4
5 Health Insurance Portability and Accountability Act of 1996 (HIPAA)
5
6 compliant de-identified or aggregate disclosures of claims and
6
7 encounter information or data.
7
8 D. Any contract in violation of this section shall be void.
8
9 SECTION 4. NEW LAW A new section of law to be codified
9
10 in the Oklahoma Statutes as Section 5412 of Title 36, unless there
10
11 is created a duplication in numbering, reads as follows:
11
12 A. Any health insurance issuer or covered service provider
12
13 shall provide information to regulated health plans in a manner that
13
14 is consistent with the Health Insurance Portability and
14
15 Accountability Act of 1996 (HIPAA) privacy and security rules and
15
16 regulations.
16
17 B. A regulated health plan that receives a disclosure under
17
18 this act from a health insurance issuer or covered service provider
18
19 shall comply with HIPAA privacy regulations in handling such
19
20 information, regardless of if HIPAA is applicable to the regulated
20
21 health plan's activities.
21
22 C. Nothing in this act shall be construed to modify HIPAA data
22
23 privacy requirements related to the creation, receipt, maintenance,
23
24 or transmission of protected health information.
24
Req. No. 3216 Page 8
1 SECTION 5. NEW LAW A new section of law to be codified
1
2 in the Oklahoma Statutes as Section 5413 of Title 36, unless there
2
3 is created a duplication in numbering, reads as follows:
3
4 A. All claims from health care providers shall be made to a
4
5 regulated health plan in accordance with transaction standards
5
6 adopted by regulation under the Health Insurance Portability and
6
7 Accountability Act of 1996 (HIPAA) as follows:
7
8 1. Institutional, professional, and dental claims shall be made
8
9 consistent with the format provided in 45 C.F.R., Section 162.1102;
9
10 or
10
11 2. Pharmacy claims shall be made consistent with the National
11
12 Council for Prescription Drug Programs or any subsequent standard
12
13 under 45 C.F.R., Section 162.1102.
13
14 B. All information provided to a regulated health plan pursuant
14
15 to this act shall be unmodified copies of the files sent by the
15
16 health care provider. Claims sent by the health care provider in a
16
17 physical format shall be converted to the appropriate standard
17
18 electronic format by the health insurance issuer or covered service
18
19 provider and made accessible at no cost to the regulated health
19
20 plan.
20
21 C. All claims payments, electronic funds transfers, and
21
22 electronic remittance advices sent by a health insurance issuer or
22
23 covered service provider under a contract with a regulated health
23
24 plan to provide, deliver, arrange for, pay for, or reimburse any of
24
Req. No. 3216 Page 9
1 the costs of health care services shall be made available to a
1
2 regulated health plan with the format provided in 45 C.F.R., Section
2
3 162.1102. Such files shall be unmodified copies of the original
3
4 information sent by the health insurance issuer or covered service
4
5 provider to a health care provider, accessible at no cost to a
5
6 regulated health plan.
6
7 D. Any contract between health insurance issuers or covered
7
8 service providers and a regulated health plan to provide, deliver,
8
9 arrange for, pay for, or reimburse any costs of health care services
9
10 shall include disclosures of all calculation formulas, pricing
10
11 methodologies, and other information used to determine the value of
11
12 reimbursements.
12
13 E. All nonclaim costs charged to a regulated health plan shall
13
14 be itemized and made available through a web portal, an application
14
15 programing interface, and a downloadable Comma-Separated Values
15
16 (.CSV) file.
16
17 F. Health insurance issuers or covered service providers shall
17
18 support automated daily batch delivery of claims, encounters,
18
19 remittances, and fee files to the regulated health plan.
19
20 SECTION 6. NEW LAW A new section of law to be codified
20
21 in the Oklahoma Statutes as Section 5414 of Title 36, unless there
21
22 is created a duplication in numbering, reads as follows:
22
23 A. All health insurance issuers and covered service providers
23
24 offering services to regulated health plans shall submit annually to
24
Req. No. 3216 Page 10
1 the Insurance Department a declaration, under penalty of perjury,
1
2 warranting compliance with this act, including attestation that:
2
3 1. Information pursuant to this act is available upon request
3
4 and is provided to regulated health plans in a timely manner; and
4
5 2. No contract contains terms that restrict or delay a
5
6 regulated health plan from auditing, reviewing, or accessing
6
7 information pursuant to this act.
7
8 B. A health insurance issuer or covered service provider shall
8
9 not delegate submission of a declaration pursuant to subsection A of
9
10 this section to a third party.
10
11 C. If a health insurance issuer or covered service provider
11
12 cannot obtain information necessary to provide the declaration
12
13 pursuant to subsection A of this section, they may submit a written
13
14 statement that includes:
14
15 1. An explanation of why they were unsuccessful in obtaining
15
16 such information, including whether auditing or access was limited;
16
17 and
17
18 2. A description of all efforts taken to remove any provisions
18
19 that violate subsection C of Section 3 of this act.
19
20 D. The Insurance Commissioner shall prescribe forms and
20
21 submission dates necessary to enforce the provisions of this act.
21
22 SECTION 7. NEW LAW A new section of law to be codified
22
23 in the Oklahoma Statutes as Section 5415 of Title 36, unless there
23
24 is created a duplication in numbering, reads as follows:
24
Req. No. 3216 Page 11
1 A. The Insurance Commissioner may assess a civil penalty not to
1
2 exceed Ten Thousand Dollars ($10,000.00) per day, per violation of
2
3 any health insurance issuer or covered service provider for
3
4 violations of this act.
4
5 B. The Commissioner may issue cease-and-desist orders and seek
5
6 injunctive relief, contract reformation, restitution of improperly
6
7 charged nonclaim costs or fees, and require corrective action plans
7
8 for violations of this act.
8
9 C. For repeated or willful violations, the Commissioner may
9
10 take action against a violator's certificate of authority or
10
11 license.
11
12 D. A health insurance issuer or covered service provider shall
12
13 not retaliate against any person for good-faith reports or
13
14 cooperation with the Insurance Department pursuant to this act.
14
15 E. The Commissioner shall promulgate rules and regulations to
15
16 enforce the provisions of this act.
16
17 SECTION 8. This act shall become effective November 1, 2026.
17
18
18
19 60-2-3216 CAD 1/15/2026 1:14:51 PM
19
20
20
21
21
22
22
23
23
24
24
Req. No. 3216 Page 12Every fact on this page links to its source, starting with the official bill record.