Oklahoma § 36-6050.2 - Definitions

§ 36-6050.2. Definitions

As used in the Out-of-Network Ambulance Service Provider Act:

1. “Ambulance service provider” means an ambulance service as

defined by Section 1-2503 of Title 63 of the Oklahoma Statutes

Oklahoma Statutes - Title 36. Insurance

except that, for the purposes of this act, the term shall be limited

to an ambulance service provider that provides ground transportation

services;

2. “Covered ambulance services” means those ground ambulance

services which an enrollee is entitled to receive under the terms of

a health care benefit plan;

3. “Enrollee” means a person who is entitled to receive covered

ambulance services under the terms of a health care benefit plan;

4. “Health care benefit plan” means a plan, policy, contract,

certificate, agreement, or other evidence of coverage for health

care services offered, issued, renewed, or extended in this state by

a health care insurer, or government-sponsored self-insured plans.

Health care benefit plan does not include any health plan offered by

a contracted entity as defined in Section 4002.2 of Title 56 of the

Oklahoma Statutes that provides coverage to members of the state

Medicaid program;

5. “Health care insurer” means an entity that is subject to

state insurance regulation and provides coverage for health benefits

in this state and includes the following:

a.

an insurance company,

b.

a health maintenance organization,

c.

a hospital and medical service corporation,

d.

a risk-based provider organization, or

e.

a sponsor or self-funded plan.

Health care insurer does not include a contracted entity as defined

in Section 4002.2 of Title 56 of the Oklahoma Statutes that provides

coverage to members of the state Medicaid program;

6. “Out-of-network” means a provider that does not contract

with the health care insurer of the enrollee receiving the covered

ambulance services; and

7. “Clean claim” means a claim that has no defect of

impropriety, including any lack of required substantiating

documentation or particular circumstances requiring special

treatment that prevents timely payment from being made on the claim.

Added by Laws 2024, c. 356, § 2, eff. Jan. 1, 2025.