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STATE OF OKLAHOMA
2nd Session of the 60th Legislature (2026)
HOUSE BILL 3928 By: Worthen
AS INTRODUCED
An Act relating to vision insurance; amending Section
2, Chapter 360, O.S.L. 2024 (36 O.S. Supp. 2025,
Section 6973), which relates to reimbursements,
charges, and pricing related to vision insurance;
modifying citation; requiring reimbursement of
licensed optometric physicians for covered services
be not less than sixtieth percentile of usual charge
for same services; prohibiting increases in
reimbursement being offset by decrease for ophthalmic
materials; providing exception for uniform
application of changes; prohibiting reduction in
reimbursements to providers for using nonaffiliated
labs or frame vendors if credentialing standards are
met; requiring disclosure of certain reimbursements;
providing for codification; and providing an
effective date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY Section 2, Chapter 360, O.S.L.
2024 (36 O.S. Supp. 2025, Section 6973), is amended to read as
follows:
Section 6973. A. No agreement between an insurer or prepaid
vision plan and a vision care provider may require that a provider
provide services or materials at a fee limited or set by the insurer
or prepaid vision plan, unless the services or materials are
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reimbursed as covered services or covered materials under the
contract.
B. A provider shall not charge more for services and materials
that are not covered services or materials to an enrollee of a
prepaid vision plan or insurer than his or her usual and customary
rate for those services and materials.
C. Reimbursements paid by an insurer or prepaid vision plan for
covered services and covered materials, regardless of the supplier
or optical lab used to obtain materials, shall be at the usual,
customary, and reasonable rate and made available to the vision care
provider prior to the provider accepting a contract from the insurer
or prepaid vision plan. An insurer or prepaid vision plan shall not
provide nominal reimbursement or advertise services and materials to
be covered with additional copay or coinsurance in order to claim
that services and materials are covered services and materials if
the health benefit plan or prepaid vision plan does not reimburse
for the services or materials.
D. Prepaid vision plans shall not in any manner impact the
pricing of noncovered services or materials.
E. Prepaid vision plans shall provide standard reimbursements
for all lenses with the same design, quality, and composition. The
period of time prescribed by a contract between any prepaid vision
plan and a provider for the plan to recover any reimbursement amount
from a provider shall be the same period of time allowed or required
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for any provider to recover any reimbursement amount from a prepaid
vision plan.
F. A prepaid vision plan shall not use extrapolation to
complete an audit of a vision care provider. Any additional payment
due to a provider or any refund to a prepaid vision plan shall be
based on actual overpayment or underpayment and shall not be based
on extrapolation.
G. A prepaid vision plan shall not incentivize patients to
receive vision care services at an entity owned wholly or in part by
the plan or subsidiaries of the plan. Any entity providing vision
care services shall provide notice to patients that an entity is
owned wholly or in part by the plan or subsidiaries of the plan.
H. No person or entity shall sell, solicit, or negotiate any
prepaid vision plan to an enrollee in this state without an approved
certificate of authority under Section 7 of this act 6978 of this
title.
I. A vision benefit plan or an insurer/insurance company,
health maintenance organization (HMO), vision benefit managers,
or nonprofit optometric service and indemnity corporation and any
affiliate, subsidiary, agent, contractor, subcontractor, or other
designee acting on behalf of, at the direction of, or under
common control with any of the foregoing, shall reimburse licensed
optometric physicians for covered services at a rate not less than
the sixtieth percentile of usual and customary charges for the same
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services or materials in the same geographic region, as determined
by a nationally known independent nonprofit that collects data from
privately billed health insurance claims as determined by the
Oklahoma Insurance Commissioner.
J. Any increase in reimbursement for covered services shall not
be offset by a decrease in reimbursement for ophthalmic materials
(including frames, lenses, and contacts), unless such changes apply
uniformly to all providers, including those owned or employed by the
vision benefit plan and including those practicing in a clinic owned
by the vision benefit plan, or the provider is employed by a company
which has any ownership by the plan.
K. A vision benefit plan or an insurer/insurance company,
health maintenance organization (HMO), vision benefit managers,
or nonprofit optometric service and indemnity corporation and any
affiliate, subsidiary, agent, contractor, subcontractor, or other
designee acting on behalf of, at the direction of, or under
common control with any of the foregoing shall not reduce
reimbursements to providers for using nonaffiliated labs or frame
vendors if they meet credentialing standards.
L. A vision benefit plan or an insurer/insurance company,
health maintenance organization (HMO), vision benefit managers,
or nonprofit optometric service and indemnity corporation and any
affiliate, subsidiary, agent, contractor, subcontractor, or other
designee acting on behalf of, at the direction of, or under
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common control with any of the foregoing shall be required to
disclose average reimbursements to affiliated and independent
providers for both services and materials.
SECTION 2. This act shall become effective November 1, 2026.
60-2-15930 MJ 01/14/26