Oklahoma SB 2011: Health benefit plans; prohibiting health benefit plan from requiring certain evidence. Effective date.

Bill Text

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STATE OF OKLAHOMA

2nd Session of the 59th Legislature (2024)

SENATE BILL 2011 By: Garvin

AS INTRODUCED

An Act relating to health benefit plans; amending 36
O.S. 2021, Section 4405.1, which relates to
credentialing; prohibiting health benefit plan from
requiring certain evidence; and providing an
effective date.

BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 36 O.S. 2021, Section 4405.1, is
amended to read as follows:
Section 4405.1. A. As used in this section:
1. a. “Health benefit plan” or “plan” means:
(1) group hospital or medical insurance coverages,
(2) not-for-profit hospital or medical service or
indemnity plans,
(3) prepaid health plans,
(4) health maintenance organizations,
(5) preferred provider plans,
(6) Multiple Employer Welfare Arrangements (MEWA), or

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(7) employer self-insured plans that are not exempt
pursuant to the federal Employee Retirement
Income Security Act (ERISA) provisions, and
b. the term “health benefit plan” shall not include:
(1) individual plans,
(2) plans that only provide coverage for a specified
disease, accidental death, or dismemberment for
wages or payments in lieu of wages for a period
during which an employee is absent from work
because of sickness or injury or as a supplement
to liability insurance,
(3) Medicare supplemental policies as defined in
Section 1882(g)(1) of the federal Social Security
Act (42 U.S.C., Section 1395ss),
(4) workers’ compensation insurance coverage,
(5) medical payment insurance issued as a part of a
motor vehicle insurance policy, or
(6) long-term care policies, including nursing home
fixed indemnity policies, unless the Insurance
Commissioner determines that the policy provides
comprehensive benefit coverage sufficient to meet
the definition of a health benefit plan; and
2. “Credentialing” or “recredentialing”, as applied to
physicians and other health care providers, means the process of

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accessing and validating the qualifications of such persons to
provide health care services to the beneficiaries of a health
benefit plan. Credentialing or recredentialing may include, but is
not limited to, an evaluation of licensure status, education,
training, experience, competence and professional judgment.
Credentialing or recredentialing is a prerequisite to the final
decision of a health benefit plan to permit initial or continued
participation by a physician or other health care provider.
B. 1. Any health benefit plan that is offered, issued or
renewed in this state shall provide for credentialing and
recredentialing of physicians and other health care providers based
on criteria provided in the uniform credentialing application
required by Section 1-106.2 of Title 63 of the Oklahoma Statutes.
2. Health benefit plans shall make information on such criteria
available to physician and other health care provider applicants,
participating physicians, and other participating health care
providers and shall provide applicants with a checklist of materials
required in the application process.
3. Physicians or other health care providers under
consideration to provide health care services under a health benefit
plan in this state shall apply for credentialing or recredentialing
on the uniform credentialing application and shall provide the
documentation as outlined in the plan’s checklist of materials
required in the application process.

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C. A health benefit plan shall determine whether a
credentialing or recredentialing application is complete. If an
application is determined to be incomplete, the plan shall notify
the applicant in writing within ten (10) calendar days of receipt of
the application. The written notice shall specify the portion of
the application that is causing a delay in processing and explain
any additional information or corrections needed.
D. 1. In reviewing the application, the health benefit plan
shall evaluate each application according to the plan’s checklist of
required materials that accompanies the application.
2. When an application is deemed complete, the plan shall
initiate requests for primary source verification and malpractice
history within seven (7) calendar days.
3. A malpractice carrier shall have twenty-one (21) calendar
days within which to respond after receipt of an inquiry from a
health benefit plan. Any malpractice carrier that fails to respond
to an inquiry within the time frame may be assess