Read the full stored bill text
An Act
ENROLLED SENATE
BILL NO. 515 By: Frix, Bullard, Bergstrom,
Jett, Grellner, Murdock,
Deevers, and Hamilton of
the Senate
and
Schreiber, Moore, Wolfley,
Hays, and Roberts of the
House
An Act relating to health care services; defining
terms; authorizing certain enrollee to send certain
documentation to certain carrier; requiring certain
health care provider to accept certain enrollee’s
payment as payment in full; prohibiting certain
health care provider from billing certain enrollee or
health benefit plan for certain amount; requiring
certain carrier to count certain amount toward
certain enrollee’s deductible and out-of-pocket
expense on certain occasion; directing certain costs
to be attributed to certain deductible; prohibiting
certain amount from exceeding certain total amount;
providing for codification; and providing an
effective date.
SUBJECT: Health care payments
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 6060.51 of Title 36, unless
there is created a duplication in numbering, reads as follows:
As used in this section:
ENR. S. B. NO. 515 Page 2
1. “Health benefit plan” means group hospital coverage,
individual and group medical insurance coverage, a not-for-profit
hospital or medical service or indemnity plan, a prepaid health
plan, a health maintenance organization plan, a preferred provider
organization plan, the Oklahoma Employees Insurance Plan, and
coverage provided by a multiple employer welfare arrangement. The
term shall not include:
a. a plan that provides coverage:
(1) only for a specified disease or diseases or under
an individual limited benefit policy,
(2) only for accidental death or dismemberment,
(3) only for dental or vision care,
(4) for a hospital confinement indemnity policy,
(5) for disability income insurance or a combination
of accident-only and disability income insurance,
or
(6) as a supplement to liability insurance,
b. any health plan offered by a contracted entity, as
defined in Section 4002.2 of Title 56 of the Oklahoma
Statutes, that provides coverage to members of the
state Medicaid program,
c. a Medicare supplemental policy as defined by Section
1882(g)(1) of the Social Security Act (42 U.S.C.,
Section 1395ss),
d. workers’ compensation insurance coverage,
e. medical payment insurance issued as part of a motor
vehicle insurance policy,
f. a long-term care policy, including a nursing home
fixed indemnity policy, unless a determination is made
ENR. S. B. NO. 515 Page 3
that the policy provides benefit coverage so
comprehensive that the policy meets the definition of
a health benefit plan, or
g. short-term health insurance issued on a nonrenewable
basis with a duration of six (6) months or less;
2. “Health care provider” means the same as defined in Section
1219.6 of Title 36 of the Oklahoma Statutes; and
3. “Health care service” means any service provided by a health
care provider, or by an individual working for or under the
supervision of a health care provider, that relates to the
diagnosis, assessment, prevention, treatment, or care of any human
illness, disease, injury, or condition.
The term shall also include mental health and substance use
disorder services, as defined by Section 6060.10 of Title 36 of the
Oklahoma Statutes, and durable medical equipment as defined by
Section 375.2 of Title 59 of the Oklahoma Statutes. The term shall
not include the administration or prescription of pharmaceutical
products or services.
SECTION 2. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6060.52 of Title 36, unless
there is created a duplication in numbering, reads as follows:
A. An enrollee may choose to pay out of pocket for a health
care service from a health care provider. If an enrollee obtains a
medically necessary health care service covered by his or her health
benefit plan and negotiates for a price lower than the average
allowed amount established by the benefit plan and provided to the
enrollee upon request, and the enrollee pays out of pocket for the
health care service, the enrollee may electronically send
documentation to the carrier that provides the following:
1. The health care service the enrollee or patient received and
the name of the health care provider and contact information;
2. If an order by the health care provider is required by the
policy, the order from the health care provider given to the
ENR. S. B. NO. 515 Page 4
enrollee or patient and the final bill or statement for the health
care service; and
3. The negotiated cost of the health care service that the
enrollee received and that:
a. the enrollee paid out of pocket for the health care
services received, and
b. the health care entity is not making a claim against
the carrier for payment for the health care service
provided to the enrollee or patient.
B. The health care provider shall accept the payment from the
enrollee as payment in full and shall not bill the enrollee or the
health benefit plan for any balance between the amount collected
from the enrollee and the billed charge for the service by the
provider.
C. A carrier that receives the documentation described in
subsection A of this section shall count the full amount that the
enrollee paid out of pocket toward the deductible and annual maximum
out-of-pocket expense if:
1. The health care service is covered under the health benefit
plan of the enrollee; and
2. The enrollee negotiated for a lower cost for the health care
service than the average allowed amount established by his or her
health benefit plan for that covered health care service.
D. The amount of the out-of-pocket cost shall be attributed to
the in-network deductible and annual maximum out-of-pocket expense
if the provider was an in-network provider, and to the out-of-
network deductible and annual maximum out-of-pocket expense if the
provider was an out-of-network provider.
E. The amount counted toward an applicable out-of-pocket
deductible and annual maximum out-of-pocket expense shall not exceed
the total amount that the enrollee is required to pay out of pocket
during a contractually agreed upon period of time for health care
services that are included under the health benefit plan of the
ENR. S. B. NO. 515 Page 5
enrollee, and shall not carry over once a new contract or agreement
period for the plan begins.
SECTION 3. This act shall become effective November 1, 2025.
ENR. S. B. NO. 515 Page 6
Passed the Senate the 25th day of March, 2025.
Presiding Officer of the Senate
Passed the House of Representatives the 5th day of May, 2025.
Presiding Officer of the House
of Representatives
OFFICE OF THE GOVERNOR
Received by the Office of the Governor this ____________________
day of ___________________, 20_______, at _______ o'clock _______ M.
By: _________________________________
Approved by the Governor of the State of Oklahoma this _________
day of ___________________, 20_______, at _______ o'clock _______ M.
_________________________________
Governor of the State of Oklahoma
OFFICE OF THE SECRETARY OF STATE
Received by the Office of the Secretary of State this __________
day of __________________, 20 _______, at _______ o'clock _______ M.
By: _________________________________