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SENATE FLOOR VERSION - SB1953 SFLR Page 1
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SENATE FLOOR VERSION
February 19, 2026
AS AMENDED
SENATE BILL NO. 1953 By: Murdock
An Act relating to health insurance; creating the
Employer Health Plan Transparency Act; providing
short title; defining terms; prohibiting certain
health plan from entering into certain contract;
prohibiting certain contract provisions from limiting
or denying certain information; prohibiting certain
contracts from containing certain provisions;
prohibiting certain contracts from prohibiting or
penalizing certain health plans in certain
situations; requiring certain contracts in violation
of certain provisions to be void; requiring certain
insurer or provider to provide certain information
consistent with certain Health Insurance Portability
and Accountability Act of 1996 (HIPAA) requirements;
requiring certain health plan to comply with certain
HIPAA requirements; construing provisions; requiring
certain claims to be made in accordance with certain
regulations; requiring certain information to be
unmodified; requiring certain notices to be in
certain formats; requiring certain disclosures by
certain issuers or providers; requiring itemization
of certain costs; requiring certain supports;
requiring submission of certain annual declaration;
requiring certain submission in certain situations;
allowing Insurance Commissioner to asses certain
civil penalties; allowing Commissioner to issue
certain orders; allowing certain action against
license in certain situations; prohibiting certain
issuer or provider from retaliating against certain
persons; requiring Commissioner to promulgate rules
and regulations; providing for noncodification;
providing for codification; and providing an
effective date.
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BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law not to be
codified in the Oklahoma Statutes reads as follows:
This act shall be known as and may be cited as the “Employer
Health Plan Transparency Act”.
SECTION 2. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 5410 of Title 36, unless there
is created a duplication in numbering, reads as follows:
As used in this act:
1. “Auditable material” means claims and encounter information
or data and any documentation supporting claim payments, including
medical records;
2. “Claims and encounter information or data” means all
documents, including electronically stored information containing
claim files, encounter data, remittance and electronic funds
transfer files, medical records supporting payment information,
policy and contract documents, and all documents or electronically
stored information containing information pursuant to 29 U.S.C.,
Section 1185m(a)(1)(B);
3. “Covered service provider” means a service provider that
enters into a contract with a regulated health plan and reasonably
expects One Thousand Dollars ($1,000.00) or more in compensation to
be received in connection with providing, delivering, arranging for,
paying for, or reimbursing any of the costs of health care services
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regardless of whether such services will be performed or
compensation received by the covered service provider, an affiliate,
or a subcontractor;
4. “Electronic funds transfer” means the electronic message a
health insurance issuer or covered service provider sends to a
financial institution to order the financial institution to
electronically transfer funds to a health care provider’s account to
pay for health care services;
5. “Electronic remittance advice” means a digital document that
a health insurance issuer or covered service provider sends to a
health care provider that supplies information about the payment to
the health care provider, including any adjustments to claims and
other payments based on factors including, but not limited to, any
adjustments to claims or other payments based on factors such as
contractual agreements, patient benefit coverage, expected co-
payments or coinsurance, and capitation payments;
6. “Encounter data” means the information relating to the
receipt of any items or service by an enrollee under a contract
between an employee and a regulated health plan;
7. “Group health plan” means an employee benefit plan that
provides medical care to employees or their dependents directly or
through insurance or reimbursement. Group health plan shall not
include Medicare supplement or accident only, fixed indemnity,
limited benefit, credit, dental, vision, specified disease, or
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Tricare supplemental insurance, long-term care or disability income,
workers’ compensation, or automobile medical payment insurance or
self-insured employee benefit plan governed by the provisions of 29
U.S.C., Section 1001 et seq.;
8. “Health care provider” means any person, group, professional
corporation, or other organization including, but not limited to,
medical clinics, medical groups, home health care agencies, health
infusion centers, urgent care centers, or emergency care centers
that are licensed or authorized in this state to furnish health care
services;
9. “Health care services” means health care related items,
products, or services rendered or furnished by a health care
provider within the scope of the provider’s license, certification,
or legal authorization for the diagnosis, prevention, treatment,
cure, or relief of a health condition, illness, injury, or disease
including, but not limited to, durable medical equipment, infusion,
imaging, and hospital, medical, surgical, and pharmaceutical
services or products;
10. “Health insurance issuer” means any entity subject to the
insurance laws and regulations of this state or subject to the
jurisdiction of the Insurance Department that contracts or offers to
contract to provide, deliver, arrange for, pay for, or reimburse any
of the costs of health care services. Health insurance issuer shall
include a sickness and accident insurance company, health
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maintenance organization, nonprofit hospital and health service
corporation, or other entity providing a plan of health insurance,
health benefits, or health services;
11. “HIPAA” means the Health Insurance Portability and
Accountability Act of 1996, P.L. No. 104-191, and all related
privacy and security regulations pursuant to the Social Security
Act, P.L. No. 74-271, 42 U.S.C., Section 1320d-9;
12. “Public employee health plan” means a governmental plan
pursuant to 29 U.S.C., Section 1002(32), which is sponsored by this
state or any political subdivision of this state, or a health
benefits program administered for the benefit of public employees or
eligible retirees;
13. “Regulated health plan” means a group health plan or a
public employee health plan as defined by this section; and
14. “Self-insured employee benefit plan” means an employee plan
where an employer assumes the financial risk for providing health
care benefits to its employees and such arrangement shall be subject
to the exclusive jurisdiction of the Employee Retirement Income
Security Act of 1974, 29 U.S.C., Section 1001 et seq.
SECTION 3. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 5411 of Title 36, unless there
is created a duplication in numbering, reads as follows:
A. A regulated health plan shall not enter into, extend, or
renew a contract with a health insurance issuer or covered service
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provider to provide, deliver, arrange for, pay for, or reimburse any
of the costs of health care services to the regulated health plan’s
employees or their dependents unless the contract or arrangement
provides the regulated health plan access to all claims and
encounter information or data, and all documentation supporting
claim payments, including medical records and policy documents
related to regulated health plan enrollee claims, are sufficient to
enable the regulated health plan to comply with applicable law and
plan terms and determine accuracy of payments.
B. No contract provision shall unreasonably:
1. Delay a regulated health plan from accessing all claims and
encounter information or data of its employees or their dependents,
and all documentation supporting claim payments related to regulated
health plan enrollee claims, including records and policy documents,
more than fifteen (15) days from the date of a request for such
information by a regulated health plan to a health insurance issuer;
2. Limit the volume of claims and encounter information or
data, and any documentation supporting claim payments of the
regulated health plan’s employees or their dependents, including
medical records and policy documents related to regulated health
plan enrollee claims, which a regulated health plan may access
during an audit or pursuant to any request by a regulated health
plan to a health insurance issuer for such information or data;
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3. Limit the disclosure of the payment arrangements of the
health insurance issuer to provide, arrange for, pay for, or
reimburse any of the costs of health care services to the regulated
health plan’s employees or their dependents, including payment
calculations and formulas, quality measures, contract terms, payment
amounts, incentive measurement periods, and other payment
methodologies;
4. Limit a regulated health plan’s right to select an auditor
to review auditable materials or limit audit frequency to less than
once per month;
5. Limit a regulated health plan from accessing claims and
encounter information or data;
6. Limit disclosure of fees charged to a regulated health plan
related to administration or claims processing, including
renegotiation fees or repricing fees;
7. Limit disclosure of information related to overpayments; or
8. Limit public disclosure of de-identified or aggregate
information that a regulated health plan receives from a health
insurance issuer or covered service provider under this act.
C. No contract between a health insurance issuer or covered
service provider and a regulated health plan shall:
1. Contain any provision that unreasonably delays or limits a
regulated health plan’s access to claims and encounter information
or data; or
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2. Not prohibit or penalize a regulated health plan for making
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
compliant de-identified or aggregate disclosures of claims and
encounter information or data.
D. Any contract in violation of this section shall be void.
SECTION 4. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 5412 of Title 36, unless there
is created a duplication in numbering, reads as follows:
A. Any health insurance issuer or covered service provider
shall provide information to regulated health plans in a manner that
is consistent with the Health Insurance Portability and
Accountability Act of 1996 (HIPAA) privacy and security rules and
regulations.
B. A regulated health plan that receives a disclosure under
this act from a health insurance issuer or covered service provider
shall comply with HIPAA privacy regulations in handling such
information, regardless of if HIPAA is applicable to the regulated
health plan’s activities.
C. Nothing in this act shall be construed to modify HIPAA data
privacy requirements related to the creation, receipt, maintenance,
or transmission of protected health information.
SECTION 5. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 5413 of Title 36, unless there
is created a duplication in numbering, reads as follows:
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A. All claims from health care providers shall be made to a
regulated health plan in accordance with transaction standards
adopted by regulation under the Health Insurance Portability and
Accountability Act of 1996 (HIPAA) as follows:
1. Institutional, professional, and dental claims shall be made
consistent with the format provided in 45 C.F.R., Section 162.1102;
or
2. Pharmacy claims shall be made consistent with the National
Council for Prescription Drug Programs or any subsequent standard
under 45 C.F.R., Section 162.1102.
B. All information provided to a regulated health plan pursuant
to this act shall be unmodified copies of the files sent by the
health care provider. Claims sent by the health care provider in a
physical format shall be converted to the appropriate standard
electronic format by the health insurance issuer or covered service
provider and made accessible at no cost to the regulated health
plan.
C. All claims payments, electronic funds transfers, and
electronic remittance advices sent by a health insurance issuer or
covered service provider under a contract with a regulated health
plan to provide, deliver, arrange for, pay for, or reimburse any of
the costs of health care services shall be made available to a
regulated health plan with the format provided in 45 C.F.R., Section
162.1102. Such files shall be unmodified copies of the original
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information sent by the health insurance issuer or covered service
provider to a health care provider, accessible at no cost to a
regulated health plan.
D. Any contract between health insurance issuers or covered
service providers and a regulated health plan to provide, deliver,
arrange for, pay for, or reimburse any costs of health care services
shall include disclosures of all calculation formulas, pricing
methodologies, and other information used to determine the value of
reimbursements.
E. All nonclaim costs charged to a regulated health plan shall
be itemized and made available through a web portal, an application
programing interface, and a downloadable Comma-Separated Values
(.CSV) file.
F. Health insurance issuers or covered service providers shall
support automated daily batch delivery of claims, encounters,
remittances, and fee files to the regulated health plan.
SECTION 6. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 5414 of Title 36, unless there
is created a duplication in numbering, reads as follows:
A. All health insurance issuers and covered service providers
offering services to regulated health plans shall submit annually to
the Insurance Department a declaration, under penalty of perjury,
warranting compliance with this act, including attestation that:
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1. Information pursuant to this act is available upon request
and is provided to regulated health plans in a timely manner; and
2. No contract contains terms that restrict or delay a
regulated health plan from auditing, reviewing, or accessing
information pursuant to this act.
B. A health insurance issuer or covered service provider shall
not delegate submission of a declaration pursuant to subsection A of
this section to a third party.
C. If a health insurance issuer or covered service provider
cannot obtain information necessary to provide the declaration
pursuant to subsection A of this section, they may submit a written
statement that includes:
1. An explanation of why they were unsuccessful in obtaining
such information, including whether auditing or access was limited;
and
2. A description of all efforts taken to remove any provisions
that violate subsection C of Section 3 of this act.
D. The Insurance Commissioner shall prescribe forms and
submission dates necessary to enforce the provisions of this act.
SECTION 7. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 5415 of Title 36, unless there
is created a duplication in numbering, reads as follows:
A. The Insurance Commissioner may assess a civil penalty not to
exceed Ten Thousand Dollars ($10,000.00) per day, per violation of
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any health insurance issuer or covered service provider for
violations of this act.
B. The Commissioner may issue cease-and-desist orders and seek
injunctive relief, contract reformation, restitution of improperly
charged nonclaim costs or fees, and require corrective action plans
for violations of this act.
C. For repeated or willful violations, the Commissioner may
take action against a violator’s certificate of authority or
license.
D. A health insurance issuer or covered service provider shall
not retaliate against any person for good-faith reports or
cooperation with the Insurance Department pursuant to this act.
E. The Commissioner shall promulgate rules and regulations to
enforce the provisions of this act.
SECTION 8. This act shall become effective November 1, 2026.
COMMITTEE REPORT BY: COMMITTEE ON BUSINESS AND INSURANCE
February 19, 2026 - DO PASS AS AMENDED