Okla. Admin. Code § 260:40-37-10

Current through Vol. 42, No. 6, December 2, 2024

Section 260:40-37-10 - Excessive Price

(a) The EBD shall have the authority to reject the bid, or to restrict enrollment in any benefits plan, for which the EBD determines the benefit price to be excessive. The EBD shall have the authority to reject any plan that does not meet the bid requirements. One way to restrict enrollment is to freeze enrollment in the plan's membership as determined to be in the best interests of the State and the members.

(b) Factors considered by the EBD in determining excessive price may include, but are not limited to utilization data and loss ratios on the State group business, a comparison to other carriers proposed prices and/or other employers' plans and prices, actuarial analyses or underwriting principles. The EBD may at its discretion, solicit a multi-part RFP which shall be designated as such. As a condition to be eligible to bid on Part II of the RFP, the EBD shall require Bidders to provide information requested in Part I of the RFP. In the event a Bidder fails to provide the information in Part I of the RFP, the EBD shall not consider the Bidder's response to the Part II of the RFP. The EBD shall retain as confidential, any proprietary information submitted by a Bidder pursuant to this paragraph.

(c) Each year, the EBD shall specify in the RFP issued by the EBD all excessive price factors that shall be considered by the EBD for that year's selection of benefit plan options. Benefits plans that bid on the RFP are deemed by the EBD to have read and accepted all excessive price factors contained in the RFP.

(d) Although the EBD shall have the authority to reject the bid, or to restrict enrollment in any benefits plan, for which the EBD determines the benefit price to be excessive, the EBD shall have no duty to do so. Despite the fact that the EBD may determine the benefit price to be excessive, the EBD nevertheless may choose not to reject the bid or restrict enrollment for reasons the EBD determines at that time to be in the best interests of the State and the members. The determining reasons will include, coverage areas where the number of other benefits plans are limited; total number of benefits plans offered; provider networks; employee participation displacement; uniformity of choices for all eligible employee groups; and premiums charged by competing plans.

(e) The particular factors that are specified in the RFP issued by the EBD for determining excessive price may vary from year to year. The specification of particular factors in prior year(s) shall serve as no precedent of the factors that may be specified in subsequent year(s). Similarly, the failure of the EBD in prior year(s) to reject a bid or restrict enrollment in any benefits plan for which the EBD determines the benefit price to be excessive, shall serve as no precedent as to the action the EBD may take in subsequent year(s).

Okla. Admin. Code § 260:40-37-10

Adopted by Oklahoma Register, Volume 31, Issue 24, September 2, 2014, eff. 9/12/2014