Oklahoma § 63-2200.32 - Prohibited actions by health carriers

§ 63-2200.32. Prohibited actions by health carriers

A. For purposes of this section:

1. "Covered person" means a policyholder, subscriber, enrollee,

member or individual covered by a health benefit plan;

2. "Health benefit plan" means a policy, contract, certificate,

or agreement entered into, offered or issued by a health carrier to

provide, deliver, arrange for, pay for or reimburse any of the costs

of health care services. Health benefit plan shall not include a

plan providing coverage for excepted benefits and short term

policies that have a term of less than twelve (12) months; and

Oklahoma Statutes - Title 63. Public Health and Safety

3. "Health carrier" means an entity subject to the insurance

laws and regulations of this state, or subject to the jurisdiction

of the Insurance Commissioner, that contracts or offers to contract

to provide, deliver, arrange for, pay for or reimburse any of the

costs of health care services including through a health benefit

plan as defined in this section, and shall include a sickness and

accident insurance company, a health maintenance organization, a

preferred provider organization or any similar entity, or any other

entity providing a plan of health insurance or health benefits.

B. A health carrier that provides coverage for anatomical

gifts, organ transplants or related treatment and services shall

not:

1. Deny coverage to a covered person solely on the basis of the

person's disability;

2. Deny to a patient eligibility, or continued eligibility, to

enroll or to renew coverage under the terms of the health benefit

plan, solely for the purpose of avoiding the requirements of this

section;

3. Penalize or otherwise reduce or limit the reimbursement of

an attending provider, or provide monetary or nonmonetary incentives

to an attending provider, to induce such provider to provide care to

an insured or enrollee in a manner inconsistent with this section;

or

4. Reduce or limit coverage benefits to a patient for the

medical services or other services related to organ transplantation

performed pursuant to this section as determined in consultation

with the attending physician and patient.

C. In the case of a health benefit plan maintained pursuant to

one or more collective bargaining agreements between employee

representatives and one or more employers, any plan amendment made

pursuant to a collective bargaining agreement relating to the plan

which amends the plan solely to conform to any requirement imposed

pursuant to this section shall not be treated as a termination of

the collective bargaining agreement.

D. Nothing in this section shall be construed to require a

health carrier to provide coverage for a medically inappropriate

organ transplant.

E. The Insurance Commissioner shall promulgate rules to

implement the provisions of this section.

Added by Laws 2021, c. 87, § 5, eff. Nov. 1, 2021.