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STATE OF OKLAHOMA
2nd Session of the 60th Legislature (2026)
SENATE BILL 1626 By: Frix
AS INTRODUCED
An Act relating to health insurance; defining terms;
prohibiting certain contracts that include certain
provisions; establishing violations that constitute
an unfair or deceptive act; allowing for certain
party to submit certain waiver to the Insurance
Commissioner; creating certain waiver; requiring
Commissioner to approve or deny certain waiver within
certain time period; establishing certain
requirements to approve certain waiver; establishing
certain contracts as null and void; allowing the
Attorney General to subpoena certain records;
allowing the Attorney General to institute certain
proceedings; subjecting certain records and papers to
inspection by the Commissioner; allowing Commissioner
to require certain health insurance carrier to
produce certain list; allowing Commissioner to impose
certain administrative penalty; allowing Commissioner
to deny sale of certain health insurance plan;
allowing Commissioner to refer certain contract to
the Attorney General; prohibiting certain changes to
privacy protections and standards; prohibiting
certain limitation of network; authorizing
Commissioner to promulgate rules and regulations;
providing for codification; and providing an
effective date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 366 of Title 36, unless there is
created a duplication in numbering, reads as follows:
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A. As used in this section:
1. “All-or-nothing clause” means a provision of a health care
contract that requires the health insurance carrier or health plan
administrator to include all members of a health care provider in a
network plan or requires the health insurance carrier or health plan
administrator to enter into any additional contract with an
affiliate of the health care provider as a condition of entering
into a contract with such health care provider;
2. “Anti-steering clause” means a provision of a health care
contract that restricts the ability of the health insurance carrier
or health plan administrator to encourage an enrollee to obtain a
health care service from a competitor of the hospital or health
system, or the ability to offer incentives to encourage enrollees to
utilize specific health care providers;
3. “Anti-tiering clause” means a provision in a health care
contract that restricts the ability of the health insurance carrier
or health plan administrator to introduce or modify a tiered network
plan or assign health care providers into tiers or requires the
health insurance carrier or health plan administrator to place all
members of a health care provider in the same tier of a tiered
network;
4. “Enrollee” means an individual who is entitled to receive
health care services under the terms of a health benefit plan;
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5. “Gag clause” means a provision of a health care contract
that restricts the ability of either the health insurance carrier,
health plan administrator, or provider to disclose:
a. any price or quality information, including the
allowed amount, negotiated rates or discounts, any
fees for services, or any other claim-related
financial obligations included in the provider
contract, to a governmental entity as authorized by
law or its contractors or agents, any enrollee,
treating provider, plan sponsor, or potential eligible
enrollee and plan sponsor, or
b. out-of-pocket costs to an enrollee;
6. “Health benefit plan” means the same as defined in Section
6060.4 of Title 36 of the Oklahoma Statutes;
7. “Health care contract” means a contract, agreement, or
understanding, entered into, amended, restated, or renewed either
orally or in writing between a health care provider and a health
insurance carrier, health plan administrator, plan sponsor, or its
contractors or agents for the delivery of health care services to an
enrollee of a health benefit plan;
8. “Health care provider” means an entity, corporation,
organization, parent corporation, member, affiliate, subsidiary, or
entity under common ownership, whether for-profit or nonprofit, that
is or whose members are licensed or otherwise authorized by this
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state to furnish, bill, or receive payment for health care service
delivery in the normal course of business, and includes health
systems, hospitals, hospital-based facilities, freestanding
emergency facilities, imaging centers, large physician groups with
eight or more physicians, physician staffing organizations, and
urgent care clinics;
9. “Health insurance carrier” means the same as defined in
Section 6592 of Title 36 of the Oklahoma Statutes;
10. “Health plan administrator” means a third-party
administrator who acts on behalf of a plan sponsor to administer a
health benefit plan;
11. “Most-favored-nations clause” means a provision of a health
care contract that:
a. prohibits or grants a health insurance carrier or
health plan administrator an option to prohibit a
participating health care provider from contracting
with another contracting entity to provide health care
services at the same or a lower price than the payment
specified in the health care contract,
b. requires or grants a health insurance carrier or
health plan administrator an option to require a
participating health care provider to accept a lower
payment in the event the participating health care
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provider agrees to provide health care services to
another contracting entity at a lower price,
c. requires or grants a health insurance carrier or
health plan administrator an option to require
termination or renegotiation of an existing health
care contract if a participating health care provider
agrees to provide health care services to another
contracting entity at the same or a lower price, or
d. restricts other health insurance carriers or health
plan administrators not party to the contract from
paying the same or lower rates for items or services
than the contracting health insurance carrier or
health plan administrator pays for such items or
services;
12. “Network plan” means a health benefit plan that either
requires enrollees to use, or creates incentives for enrollees to
use, certain health care providers managed, owned, affiliated, under
contract with, or employed by a health insurance carrier, a health
plan administrator, or plan sponsor. Network plans include health
maintenance organization (HMO) plans, preferred provider
organization (PPO) plans, and exclusive provider organization (EPO)
plans; and
13. “Tiered network plan” means a health benefit plan that
sorts health care providers into specific groups to which different
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provider reimbursement, enrollee cost sharing, or provider access
requirements are applied for the same services.
B. Except as provided in this subsection, no health insurance
carrier, health care provider, health plan administrator, or any
agent or other entity that contracts on behalf of a health insurance
carrier, a health care provider, or a health plan administrator
shall offer, solicit, request, amend, renew, or enter into a health
care contract that would include any of the following provisions:
1. An all-or-nothing clause;
2. An anti-steering clause;
3. An anti-tiering clause;
4. A gag clause;
5. A most-favored-nations clause; or
6. Any other clause that results or intends to result in
anticompetitive effects as specified through regulation by the
Insurance Commissioner.
C. Except as provided in subsection D of this section, a
violation of this section constitutes an unfair or deceptive act
under Section 1204 of Title 36 of the Oklahoma Statutes and shall be
subject to enforcement by the Attorney General.
D. 1. A party to a health care contract that contains a
provision specified in subsection B of this section may submit the
health care contract to the Commissioner for a waiver. The health
care contract shall be accompanied by:
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a. the name and business address of each party to the
health care contract,
b. any identification of each location at which any party
to the agreement or policy provides health care
services, and
c. any information required to demonstrate that the
proposed agreement or policy results in an improvement
in the welfare of consumers in this state that could
not have been accomplished through alternative means
that are less restrictive.
2. The Commissioner shall approve or deny any waiver
application in writing within sixty (60) days. The Commissioner may
approve a waiver to allow a contract to include a provision pursuant
to subsection B of this section if the Commissioner determines that:
a. the agreement or policy results in an improvement in
the welfare of consumers in this state such that the
competitive benefit of including the provision
outweighs the harm to competition,
b. such improvement in the welfare could not have been
accomplished through alternative means that are less
restrictive, and
c. the agreement or policy shall not otherwise constitute
a contract, combination, or conspiracy in restraint of
trade.
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3. Except for contracts granted a waiver under this subsection,
any provision of a health care contract described in subsection B of
this section shall be unenforceable.
E. The Attorney General may subpoena any records necessary to
enforce any provisions of this section or to investigate suspected
violations of any provisions of this section. The Attorney General
may institute proceedings on behalf of this state or as parens
patriae of the persons residing in this state for injunctive relief
to prevent and restrain a violation of any provision of this
section, civil penalties for violations of the provisions of
subsection D of this section, criminal penalties for violations of
the provisions of subsection D of this section, and other equitable
relief for violations of the provisions of this section including,
without limitation, disgorgement or restitution.
F. 1. All records and papers of health insurance carriers
pertaining to health benefit plans or negotiations between the
health insurance carrier and any health care provider shall be
subject to inspection by the Commissioner or by any agent he or she
may designate for that purpose. The Commissioner may require any
health insurance carrier to produce a list of all health care
contracts, transactions, or pricing agreements entered into within
the preceding twelve (12) months.
2. Except for contracts granted a waiver under subsection D of
this section, the Commissioner may impose an administrative penalty
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of up to Five Thousand Dollars ($5,000.00) upon a health insurance
carrier per day for each day that a contract that has been deemed
unenforceable pursuant to subsection D of this section is in effect.
3. The Commissioner may deny the sale of any health insurance
plan where the contract between the health insurance carrier and any
health care provider is in violation of subsection D of this
section.
4. The Commissioner may refer any health care contract subject
to this section to the Attorney General to review for compliance
with this section. The referral of any health care contract by the
Commissioner to the Attorney General shall not constitute a
violation any confidentiality agreement between the health insurance
carrier and the Commissioner that may exist under Title 36 of the
Oklahoma Statutes. The authority of the Attorney General to
prosecute violations of antitrust or consumer protection
requirements shall not be altered by this section.
G. Any party that suffers a loss as a result of the violation
of this section shall be entitled to initiate an action and seek all
remedies, damages, costs, and fees.
H. Nothing in this section shall be construed to limit network
design, cost, or quality initiatives by a group health plan, health
insurance carrier, or administrators working on behalf of a plan
sponsor, including accountable care organizations, exclusive
provider organizations, networks that tier providers by cost or
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quality or steer enrollees to centers of excellence, or other pay-
for-performance programs.
I. The Commissioner may promulgate rules and regulations
necessary for the provisions of this section.
SECTION 2. This act shall become effective November 1, 2026.
60-2-2456 CAD 1/13/2026 4:38:24 PM