Oklahoma § 36-6060.4 - Child immunization coverage

§ 36-6060.4. Child immunization coverage

A. A health benefit plan delivered, issued for delivery or

renewed in this state on or after January 1, 1998, that provides

benefits for the dependents of an insured individual shall provide

coverage for each child of the insured, from birth through the date

the child is eighteen (18) years of age for:

1. Immunization against:

a.

diphtheria,

b.

hepatitis B,

Oklahoma Statutes - Title 36. Insurance

c.

measles,

d.

mumps,

e.

pertussis,

f.

polio,

g.

rubella,

h.

tetanus,

i.

varicella,

j.

haemophilus influenzae type B, and

k.

hepatitis A; and

2. Any other immunization subsequently required for children by

the State Board of Health.

B. Benefits required pursuant to subsection A of this section

shall not be subject to a deductible, co-payment, or coinsurance

requirement.

C. 1. For purposes of this section, "health benefit plan"

means group hospital coverage, individual and group medical

insurance coverage, a not-for-profit hospital or medical service or

indemnity plan, a prepaid health plan, a health maintenance

organization plan, a preferred provider organization plan, the State

and Education Employees Group Health Insurance Plan, and coverage

provided by a Multiple Employer Welfare Arrangement or employee

self-insured plan as permitted under Employee Retirement Income

Security Act of 1974.

2. The term "health benefit plan" shall not include:

a.

a plan that provides coverage:

(1) only for a specified disease or diseases or under

an individual limited benefit policy,

(2) only for accidental death or dismemberment,

(3) only for dental or vision care,

(4) a hospital confinement indemnity policy,

(5) disability income insurance or a combination of

accident-only and disability income insurance, or

(6) as a supplement to liability insurance,

b.

a Medicare supplemental policy as defined by Section

1882(g)(1) of the Social Security Act (42 U.S.C.,

Section 1395ss),

c.

workers' compensation insurance coverage,

d.

medical payment insurance issued as part of a motor

vehicle insurance policy,

e.

a long-term care policy, including a nursing home

fixed indemnity policy, unless a determination is made

that the policy provides benefit coverage so

comprehensive that the policy meets the definition of

a health benefit plan, or

f.

short-term health insurance issued on a nonrenewable

basis with a duration of six (6) months or less.

Oklahoma Statutes - Title 36. Insurance

Added by Laws 1997, c. 75, § 1, eff. Nov. 1, 1997. Amended by Laws

2000, c. 61, § 1, eff. Nov. 1, 2000; Laws 2003, c. 464, § 6, eff.

July 1, 2003; Laws 2006, c. 264, § 65, eff. July 1, 2006; Laws 2010,

c. 222, § 33, eff. Nov. 1, 2010; Laws 2016, c. 73, § 7, eff. Nov. 1,

2016; Laws 2022, c. 199, § 2, eff. Nov. 1, 2022; Laws 2024, c. 195,

§ 10, eff. Nov. 1, 2024.

§36-6060.4a. Claims in conjunction with arrest or pretrial

detention.

A. No health benefit plan, including, but not limited to, the

State and Education Employees Group Health Insurance Plan, that is

offered, issued or renewed in the state on or after January 1, 2009,

shall exclude otherwise allowable claims which occur in conjunction

with the arrest or pretrial detention of the policyholder prior to

adjudication of guilt and sentencing to incarceration of the

policyholder. The reimbursement rate for out-of-network claims for

these services shall be set at the current Medicare rate.

B. 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.

Added by Laws 2008, c. 351, § 1, eff. Nov. 1, 2008. Amended by Laws

2010, c. 222, § 34, eff. Nov. 1, 2010.

§36-6060.4b. Standard serological tests for syphilis.

A. As used in this section:

1. “Health benefit plan” has the same meaning as provided by

Section 6060.4 of Title 36 of the Oklahoma Statutes; and

2. “Medically necessary” means services or supplies provided by

a health care provider that are:

a.

provided for the diagnosis of syphilis,

b.

necessary for and appropriate to the diagnosis of

syphilis,

c.

within the generally accepted standards of medical

care in the community, and

d.

not solely for the convenience of the insured, the

insured’s family, or the provider.

B. A health benefit plan shall cover the cost of medically

necessary standard serological tests for syphilis required under

Section 1-515 of Title 63 of the Oklahoma Statutes.

Added by Laws 2023, c. 116, § 1, eff. Nov. 1, 2023.