Oklahoma § 36-6060.3 - Maternity benefits - Postpartum care

§ 36-6060.3. Maternity benefits - Postpartum care

A. Every health benefit plan issued, amended, renewed or

delivered in this state on or after July 1, 1996, that provides

maternity benefits shall provide for coverage of:

1. A minimum of forty-eight (48) hours of inpatient care at a

hospital, or a birthing center licensed as a hospital, following a

vaginal delivery, for the mother and newborn infant after

childbirth, except as otherwise provided in this section;

2. A minimum of ninety-six (96) hours of inpatient care at a

hospital following a delivery by caesarean section for the mother

and newborn infant after childbirth, except as otherwise provided in

this section; and

3.

a.

Postpartum home care following a vaginal delivery if

childbirth occurs at home or in a birthing center that

is not licensed as a hospital but that is accredited

as a freestanding birth center by the Commission for

the Accreditation of Birth Centers. The coverage

shall provide for one home visit within forty-eight

(48) hours of childbirth by a licensed health care

provider whose scope of practice includes providing

postpartum care. Visits shall include, at a minimum:

(1) physical assessment of the mother and the newborn

infant,

(2) parent education, to include, but not be limited

to:

(a) the recommended childhood immunization

schedule,

(b) the importance of childhood immunizations,

and

(c) resources for obtaining childhood

immunizations,

(3) training or assistance with breast or bottle

feeding, and

(4) the performance of any medically necessary and

appropriate clinical tests.

Oklahoma Statutes - Title 36. Insurance

b.

At the discretion of the mother, visits may occur at

the facility of the plan or the provider.

B. Inpatient care shall include, at a minimum:

1. Physical assessment of the mother and the newborn infant;

2. Parent education, to include, but not be limited to:

a.

the recommended childhood immunization schedule,

b.

the importance of childhood immunizations, and

c.

resources for obtaining childhood immunizations;

3. Training or assistance with breast or bottle feeding; and

4. The performance of any medically necessary and appropriate

clinical tests.

C. A plan may limit coverage to a shorter length of hospital

inpatient stay for services related to maternity and newborn infant

care provided that:

1. In the sole medical discretion or judgment of the attending

physician licensed by the State Board of Medical Licensure and

Supervision or the State Board of Osteopathic Examiners or the

certified nurse midwife licensed by the Oklahoma Board of Nursing

providing care to the mother and to the newborn infant, it is

determined prior to discharge that an earlier discharge of the

mother and newborn infant is appropriate and meets medical criteria

contained in the most current treatment standards of the American

Academy of Pediatrics and the American College of Obstetricians and

Gynecologists that determine the appropriate length of stay based

upon:

a.

evaluation of the antepartum, intrapartum and

postpartum course of the mother and newborn infant,

b.

the gestational age, birth weight and clinical

condition of the newborn infant,

c.

the demonstrated ability of the mother to care for the

newborn infant post-discharge, and

d.

the availability of post-discharge follow-up to verify

the condition of the newborn infant in the first

forty-eight (48) hours after delivery.

A plan shall adopt these guidelines by July 1, 1996; and

2. The plan covers one home visit, within forty-eight (48)

hours of discharge, by a licensed health care provider whose scope

of practice includes providing postpartum care. The visits shall

include, at a minimum:

a.

physical assessment of the mother and the newborn

infant,

b.

parent education, to include, but not be limited to:

(1) the recommended childhood immunization schedule,

(2) the importance of childhood immunizations, and

(3) resources for obtaining childhood immunizations,

c.

training or assistance with breast or bottle feeding,

and

Oklahoma Statutes - Title 36. Insurance

d.

the performance of any medically necessary and

clinical tests.

At the mother’s discretion, visits may occur at the facility of

the plan or the provider.

D. The plan shall include, but is not limited to, notice of the

coverage required by this section in the evidence of coverage of the

plan, and shall provide additional written notice of the coverage to

the insured or an enrollee during the course of the prenatal care of

the insured or enrollee.

E. In the event the coverage required by this section is

provided under a contract that is subject to a capitated or global

rate, the plan shall be required to provide supplementary

reimbursement to providers for any additional services required by

that coverage if it is not included in the capitation or global

rate.

F. No health benefit plan subject to the provisions of this

section shall terminate the services of, reduce capitation payments

for, refuse payment for services, or otherwise discipline a licensed

health care provider who orders care consistent with the provisions

of this section.

G. As used in this section:

1. “Birthing center” has the same meaning as provided by

Section 1-701 of Title 63 of the Oklahoma Statutes; and

2. “Health benefit plan” means any plan or arrangement as

defined in subsection C of Section 6060.4 of this title.

H. The Insurance Commissioner shall promulgate any rules

necessary to implement the provisions of this section.

Added by Laws 1996, c. 164, § 1, emerg. eff. May 14, 1996. Amended

by Laws 1997, c. 149, § 1, eff. Nov. 1, 1997; Laws 2003, c. 464, §

5, eff. July 1, 2003; Laws 2010, c. 222, § 31, eff. Nov. 1, 2010;

Laws 2024, c. 132, § 1, eff. Nov. 1, 2024.

§36-6060.3a. Annual obstetrical/gynecological examinations.

A. Any health benefit plan, including the State and Education

Employees Group Health Insurance plan, that is offered, issued or

renewed in this state on or after January 1, 2005, that provides

medical and surgical benefits shall provide coverage for routine

annual obstetrical/gynecological examinations.

B. The benefit required to be provided by this section shall in

no way diminish or limit diagnostic benefits otherwise allowable

under a health benefit plan.

C. Nothing in this section shall be construed as requiring such

routine annual examination to be performed by an obstetrician,

gynecologist, or obstetrician/gynecologist.

D. As used in this section, “health benefit plan” means any

plan or arrangement as defined in subsection C of Section 6060.4 of

this title, except that the term “health benefit plan” does not

Oklahoma Statutes - Title 36. Insurance

include policies or certificates issued to individuals or groups

with fewer than fifty employees.

E. The provisions of this section shall not apply to policies

or certificates issued to individuals or groups with fewer than

fifty employees.

Added by Laws 2004, c. 397, § 1, eff. Nov. 1, 2004. Amended by Laws

2010, c. 222, § 32, eff. Nov. 1, 2010.

§36-6060.3b. Contraceptive drug coverage.

A. As used in this section:

1. “Contraceptive drugs” means all drugs approved by the United

States Food and Drug Administration that are used to prevent

pregnancy including but not limited to hormonal drugs administered

orally, transdermally, and intravaginally; and

2. “Health benefit plan” means a health benefit plan as defined

pursuant to Section 6060.4 of Title 36 of the Oklahoma Statutes.

B. Any health benefit plan that is offered, issued, or renewed

on or after the effective date of this act that offers coverage for

contraceptive drugs shall provide coverage for an enrollee to

obtain:

1. A three-month supply of a contraceptive drug at once the

first time the enrollee obtains the drug; and

2. A six-month supply of the contraceptive drug at once each

subsequent time that the enrollee obtains the same drug, regardless

of whether the enrollee was enrolled in the health benefit plan the

first time that the enrollee obtained the drug.

An enrollee may obtain only one six-month supply of a covered

prescription drug during each six-month period.

C. Nothing in this section shall be construed to prohibit an

enrollee of a health benefit plan from requesting a smaller supply

or to prohibit a prescribing provider from prescribing a smaller

supply if such a prescription is supported by clinical utility and

medical appropriateness.

D. Nothing in this section shall be construed to require

coverage under a health benefit plan for any medications that could

be used to terminate an existing pregnancy.

Added by Laws 2025, c. 398, § 1, eff. Nov. 1, 2025.