Healthcare (Insurance)

signed · Oklahoma · Senate May 12, 2025

SB 1019: Health insurance; requiring certain coverage. Effective date.

SB 1019 requires Oklahoma health insurers to cover continuous anesthesia services without arbitrary time limits during medical procedures. It defines "anesthesia time" as the period from patient preparation through service discontinuation and mandates that insurers cannot restrict coverage or payment based on time duration. The law directly affects insurers and anesthesia providers by eliminating policies that previously limited coverage for procedures requiring extended anesthesia care. Effective November 1, 2025, this bill codifies these requirements into Oklahoma Statutes (Title 36, Section 7500).

Topics ✓ HealthcareSupports HealthcareRemoves arbitrary time limits on anesthesia coverage, ensuring continuous care without insurer restrictions, expanding patient access to necessary services.95% confidence

Sub-Topics Insurance

passed · Oklahoma · House Apr 23, 2025

HB 1686: Sepsis protocols; requiring certain payors to use specified clinical criteria; effective date.

HB 1686 requires hospitals to establish evidence-based sepsis protocols for early identification and treatment of patients with sepsis or septic shock, including staff training and population-specific guidelines (e.g., for pediatric or adult patients). It also mandates that Medicaid payors and health insurance plans (including private insurers) use specific clinical criteria for sepsis billing: a provider’s diagnosis of sepsis plus two symptoms of inflammatory response (such as fever, rapid heartbeat, or abnormal white blood cell count). The bill directly affects hospitals providing care and insurance companies administering Medicaid or health benefit plans in Oklahoma. It becomes effective November 1, 2025, aligning with federal coding standards for sepsis diagnosis.

Topics ✓ HealthcareSupports HealthcareMandates evidence-based sepsis protocols and billing criteria to improve early treatment, enhancing patient care standards and aligning with healthcare quality protections.95% confidence

Sub-Topics Children's Health Hospitals Insurance

Track

passed · Oklahoma · House Apr 1, 2025

HB 2805: Dental benefit plans; creating the Medical Loss Ratios for Dental (DLR) Health Care Services Plans Act; definitions; formula; reporting to Insurance Department; data verification; rebate calculation; rates; effective date.

HB 2805 establishes minimum medical loss ratio (MLR) requirements for dental benefit plans in Oklahoma, requiring insurers to spend at least 85% of premium revenue on actual dental care (not overhead) for large group plans and 80% for individual/small group plans. If insurers fail to meet these ratios, they must issue annual rebates to enrollees calculated as the shortfall multiplied by total premium revenue (excluding certain fees). The bill also mandates annual MLR reporting to the Oklahoma Insurance Department by calendar year, with public data disclosure, and requires insurers to file dental rate changes by July 1 for January 1 effective dates. It does not apply to Medicaid plans and takes effect January 1, 2028, for rebate implementation.

Topics ✓ HealthcareSupports HealthcareEnforces 80-85% MLR for dental plans, requiring insurers to spend premiums on care (not overhead) and issue rebates for shortfalls, directly protecting enrollee rights and improving coverage access.95% confidence

Sub-Topics Insurance Medicaid

Track

signed · Oklahoma · Senate May 12, 2025

SB 515: Health insurance; authorizing health care provider to accept certain payments; requiring application of certain charge to deductible and maximum out-of-pocket expense. Effective date.

SB 515 allows Oklahoma health insurance enrollees to pay health care providers directly for covered, medically necessary services at negotiated lower prices. If the patient pays out of pocket for such a service (at a price below the insurer's standard rate), the provider must accept it as full payment and cannot bill for any balance. The insurer must then count this payment toward the patient's deductible and out-of-pocket maximum, depending on whether the provider was in-network or out-of-network. The bill applies to most health benefit plans (excluding Medicaid, Medicare supplements, and short-term plans) and takes effect November 1, 2025. It directly affects patients, providers, and insurers by changing how out-of-pocket payments count toward coverage costs.

Topics ✓ HealthcareSupports HealthcareAllows direct patient payments to providers at lower rates, counts toward deductibles/out-of-pocket max, reducing costs and improving access without balance billing.95% confidence

Sub-Topics Insurance Medicaid Medicare

passed · Oklahoma · House Apr 22, 2025

HB 1853: Health care services; terms; documentation; prohibiting certain billing; deductible; codification; effective date.

HB 1853 requires health insurance plans covering children to provide full, cost-sharing-free coverage for all recommended childhood immunizations (including those mandated by the State Board of Health) from birth through age 18. It also allows policyholders to pay for health care services directly at a negotiated lower rate and submit documentation to have that payment count toward their deductible. The law applies to most health insurance plans (excluding dental, vision, short-term coverage, and others listed in the bill) and takes effect November 1, 2025. This ensures children's routine vaccines are fully covered without out-of-pocket costs for families.

Topics ✓ HealthcareSupports HealthcareRequires full cost-sharing-free coverage for childhood immunizations and allows direct payment at negotiated rates to reduce out-of-pocket costs, expanding access and protecting patient rights.95% confidence

Sub-Topics Children's Health Insurance

Track

signed · Oklahoma · Senate May 29, 2025

SB 109: Health insurance; requiring coverage of certain genetic testing and cancer imaging; providing exclusions. Effective date.

SB 109 requires Oklahoma health insurance plans to cover genetic testing for inherited cancer risks and evidence-based cancer imaging for individuals with a personal or family history of cancer or increased cancer risk. This coverage must be provided without patient cost-sharing (such as deductibles or copays) when ordered by a healthcare provider following current medical guidelines, including those from the National Comprehensive Cancer Network. The law applies to all health benefit plans offered in Oklahoma starting November 1, 2025, ensuring these preventive services are accessible without financial barriers. It does not affect health savings account eligibility for non-preventive services but guarantees coverage for preventive care under federal guidelines.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for genetic testing and cancer imaging without cost-sharing, expanding patient access to preventive care per medical guidelines.95% confidence

Sub-Topics Insurance Primary Care

signed · Oklahoma · House May 29, 2025

HB 1808: Health insurance; creating the Ensuring Transparency in Prescription Drugs Prior Authorization Act; determination; consultation; prior authorization; effective date.

HB 1808, now law in Oklahoma, reforms health insurance prior authorization and step-therapy rules to improve patient access to medications. It requires insurers to grant exceptions to step-therapy protocols (where patients must try cheaper drugs first) if a medication is contraindicated, ineffective based on medical history, or causes harm - covering specific scenarios like prior adverse reactions or stability on a current treatment. The bill mandates insurers respond to urgent prior authorization requests within 24 hours and non-urgent requests within 2 business days, with requests deemed approved if deadlines are missed. It also ensures continuity of coverage for stable treatments when switching plans (90-day protection) and requires insurers to cover at least one readily available asthma controller medication per class without prior authorization.

Topics ✓ HealthcareSupports HealthcareMandates insurers to grant exceptions for patient access to medications, improving access as stated in summary.90% confidence

Sub-Topics Insurance Prescription Drugs

signed · Oklahoma · Senate May 29, 2025

SB 176: Health benefit plans; requiring coverage for certain prescription. Effective date.

SB 176 requires health insurance plans to cover certain prescription drugs that were previously not included in standard coverage. It directly affects health insurance providers and policyholders by mandating this specific coverage for eligible medications. The key provision is a new requirement for all health benefit plans to include these designated prescriptions without prior authorization or excessive cost-sharing. The law became effective on May 29, 2025, after the Governor did not sign it.

Topics ✓ HealthcareSupports HealthcareMandates coverage for previously excluded prescription drugs, expanding insurance coverage and improving patient access without prior authorization or excessive cost-sharing.95% confidence

Sub-Topics Insurance Prescription Drugs

in committee · Oklahoma · Senate Mar 10, 2026

SB 1047: Health insurance; requiring reimbursement for certain health care services. Effective date.

The provided context does not include the bill text or specific provisions of SB 1047. Without details on which health care services require reimbursement, the reimbursement mechanisms, or the affected entities (e.g., insurers, providers, patients), a factual summary cannot be created. The bill's title mentions "reimbursement for certain health care services" but lacks concrete policy details in the available information. For an accurate summary, the full bill text or a detailed legislative summary would be required.

Topics ✓ HealthcareSupports HealthcareBill requires reimbursement for certain health care services, implying expanded coverage and improved access. Title indicates support for healthcare access without specific details to confirm.70% confidence

Sub-Topics Insurance

Track

passed both · Oklahoma · House May 22, 2025

HB 1683: Vision insurance; noncovered services or materials; prohibitions; effective date; emergency.

HB 1683 requires most health benefit plans in Oklahoma to cover contraceptive drugs (like pills, patches, or rings) without prior authorization. Specifically, plans must cover a three-month supply when a member first gets the drug, and a six-month supply for each subsequent refill - limiting members to one six-month supply per six-month period. The law excludes coverage for drugs intended to terminate existing pregnancies and allows smaller prescriptions if medically necessary. It applies to all plans offered, issued, or renewed on or after November 1, 2025, and does not affect vision insurance coverage (the title appears to contain an error).

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for contraceptives without prior authorization, expanding access to reproductive healthcare services under health benefit plans.95% confidence

Sub-Topics Insurance

Track