Oklahoma § 36-6060.42 - Shared savings incentive program

§ 36-6060.42. Shared savings incentive program

A. An insurance carrier may offer a shared savings incentive

program to provide incentives to an enrollee when the enrollee

obtains a comparable health care service that is covered by the

carrier from providers that charge less than the average allowed

amount paid by that carrier to network providers for that,

comparable health care service.

B. Incentives may be calculated as a percentage of the

difference in allowed amounts to the average, as a flat dollar

amount, or by any other reasonable methodology approved by the

Insurance Department. The carrier shall provide the incentive as a

cash payment to the enrollee or credit toward the annual in-network

deductible and out-of-pocket limit of the enrollee. Carriers may

allow enrollees to select which method the enrollee prefers to

receive the incentive.

C. An insurance carrier that offers a shared savings incentive

program shall:

1. Establish the program as a component part of the policy or

certificate of insurance provided by the carrier and notify the

enrollees and the Insurance Department at least thirty (30) days

before program termination;

2. File a description of the program on a form prescribed by

the Insurance Commissioner. The Insurance Department shall review

the filing and determine whether the program complies with the

provisions of this section;

3. Notify an enrollee, annually or at the time of renewal, of

the availability of the shared savings incentive program and the

procedures to participate in the program;

4. Publish on the website of the insurance carrier, easily

accessible to enrollees and applicants for insurance, a list of

comparable health care services and health care providers and the

shared savings incentive amount applicable for each service. A

shared savings incentive shall not be less than twenty-five percent

Oklahoma Statutes - Title 36. Insurance

(25%) of the savings generated by the participation of the enrollee

in any shared savings incentive program offered by the insurance

carrier. The baseline for the savings calculation shall be the

average in-network amount paid for that service in the most recent

twelve-month period or any other methodology established by the

insurance carrier and approved by the Insurance Department;

5. At least quarterly, credit, deposit or make a cash payment

to an enrollee of the shared savings incentive amount pursuant to

participation in the shared savings incentive program; and

6. Submit an annual report to the Insurance Department within

ninety (90) days after the close of each health benefit plan year.

At a minimum, the report shall include the following information:

a.

the number of enrollees who participated in the

program during the health benefit plan year and the

number of instances of participation,

b.

the total cost of services provided as a part of the

program, and

c.

the total value of the shared savings incentive

payments made to enrollees participating in the

program and the values distributed as cash or credit

toward the annual in-network deductible and out-ofpocket limit of an enrollee.

D. An enrollee shall not be required to participate in a shared

savings incentive program.

Added by Laws 2022, c. 151, § 3.